Research Highlights:
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Having easier access to primary care doctors can increase awareness and control of high blood pressure, regardless of where a person lives, according to new research published in Circulation: Cardiovascular Quality and Outcomes , a peer-reviewed journal of the American Heart Association .
According to the American Heart Association, nearly half of all Americans have hypertension (high blood pressure) and many don’t even know they have it. High blood pressure is often called the "silent killer" because high blood pressure often has no obvious symptoms. The best ways to protect yourself are to be aware of the risks and make important healthy lifestyle changes.
In a new study, researchers say health care professionals in community clinics and primary care offices can help expand awareness and detection of high blood pressure by providing affordable treatment and management. High blood pressure is one of the leading preventable risk factors for cardiovascular disease, and effective blood pressure control reduces associated cardiovascular health risks.
“Access to primary care is the key to controlling hypertension, yet many Americans have limited access to primary care where they live. This is especially true for people in economically disadvantaged neighborhoods or people from diverse racial and ethnic groups, particularly among African Americans,” said the study’s lead author, Brisa Aschebrook-Kilfoy, Ph.D., associate professor of health sciences. public at the University of Chicago in Illinois.
It is well known that better access to primary health care is linked to better awareness and control of high blood pressure. This study sought to clarify whether people living in disadvantaged neighborhoods can benefit from improved access to primary care health professionals.
In this study, neighborhood socioeconomic status was assessed using the Area Deprivation Index (ADI) created by the Health Resources and Services Administration (HRSA) more than three decades ago. The ADI was chosen because it allows neighborhoods to be ranked by socioeconomic disadvantage in a region of interest (e.g., at the state or national level), and is valuable in informing health care delivery and policy, especially for the most disadvantaged neighborhood groups. ADI is made up of 17 indicators covering income, education, employment and housing quality. In this study, socioeconomically disadvantaged neighborhoods were defined as those in census tracts ranked at the 50th percentile or higher.
“Some argue that minority health disparities are solely the product of socioeconomic factors, or that increasing the number of primary care professionals in racially and ethnically diverse neighborhoods would not reduce health disparities or improve public health. To our knowledge, there is little research to support or refute this argument,” said the study’s first author, Jiajun Luo, Ph.D., a postdoctoral fellow at the Institute for Population and Precision Health at the University of Chicago. "We conducted this study to examine whether primary care accessibility is associated with better hypertension control and awareness of various neighborhood and socioeconomic factors."
The study examined Chicago, one of the most racially segregated cities in the U.S. Chicago’s South Side is the largest African American urban community in the U.S., with substantial challenges including poverty, violence and decreased access to fresh and healthy foods. According to the study, a 30-year gap in life expectancy has been observed between people living in Chicago’s South Side neighborhoods and wealthier North Side neighborhoods, which can largely be attributed to the higher rates. of high blood pressure, heart disease and stroke.
Researchers analyzed health data from more than 5,000 predominantly African American adults who participated in the Chicago Multi-Ethnic Prevention and Surveillance Study (COMPASS) between 2013 and 2019. COMPASS is a long-term initiative at the University of Chicago that explores health of Chicagoans, primarily those who live in communities on the South Side. MAPSCorps, a nonprofit organization, provided information on the location of primary care professionals providing care in those Chicago neighborhoods.
More than half of the study participants were smokers and reported an annual household income of less than $15,000, and more than 37% were obese based on body mass index (BMI). The majority of the study population resided in a Chicago neighborhood with an ADI rank above the 70th percentile (communities with the greatest disadvantages).
The researchers also assessed spatial accessibility, which is a composite score that considers the distance between an individual’s residence and local primary health care facilities; the relationship between the number of doctors and the population; and the effect of distance to primary care on an individual’s willingness to seek primary health care. A higher spatial accessibility score indicated better accessibility to primary care. Primary health care professionals included family physicians, general practitioners, and general internists.
The investigation found:
- Nearly 80% of COMPASS participants had documented hypertension, using standard blood pressure criteria based on the American Heart Association guidelines of measurements systolic ≥130 mm Hg (top number) or diastolic ≥80 mm Hg (number lower).
- Nearly 38% of people with hypertension did not have their blood pressure under control (not receiving treatment based on self-report), and 41% did not know they had high blood pressure.
- Spatial accessibility scores ranged from 16.4 (lowest access to primary care) to 86.6 (highest access) per 100,000 inhabitants.
- Adults who lived in areas with the fewest primary health care professionals were 37% more likely to have hypertension compared to adults who lived in neighborhoods with the highest number of primary care doctors.
- The associations listed existed in both poor and wealthy neighborhoods, suggesting that residents of all neighborhoods can benefit from increasing the number of primary care professionals.
- When stratified by neighborhood type (advantaged or disadvantaged), accessibility to primary care was not associated with antihypertensive medication use among those who reported having hypertension before enrolling in the study.
“Based on these findings, we should encourage primary care physicians to expand access to people living in underserved communities with the fewest number of primary care professionals,” Aschebrook-Kilfoy said. “Mobile health units can be one approach to increasing primary care service in underserved areas by eliminating the challenge of obtaining transportation to and from an office visit. The use of antihypertensive medications also needs to be studied and addressed, especially since it was not linked to accessibility to primary care in this study.”
While the method used in this study to measure spatial accessibility can be used anywhere with sufficient information about the location of primary care professionals, a major limitation of this study is that these specific results may not be representative of other communities. and population groups, such as the middle-aged. urban class communities or people from other diverse racial and ethnic groups, etc.
Co-authors are Muhammad G. Kibriya, Ph.D.; Paul Zakin, B.S.; Andrew Craver, MPH; Liz Connellan, MPH; Saira Tasmin, Ph.D.; Tamar Polonsky, MD; Karen Kim, MD; and Habibul Ahsan, MD Author disclosures are listed in the manuscript.
