Evaluating Control of Hypertension - Effect of Social Determinants

The Affordable Care Act (ACA) enacted several provisions intended to improve healthcare for
vulnerable populations,including expanding Medicaid eligibility to those earning ≤138% of the
federal poverty level (FPL). Since the expansion was not required, as of March 2018, 32
states (and District of Columbia) implemented the expansion and 18 did not. Simulated models
predicted the ACA would improve health outcomes and reduce disparities for patients with
hypertension, yet actual changes are not yet available. In addition, there is new interest in
tracking and utilizing Social Determinants of Health (SDH) in the primary care setting but
there is currently little information on how this information will impact Hypertension (HTN)
care, especially related to changes to health insurance availability. This study will build
on current understanding of how health insurance impacts HTN incidence, screening, treatment,
and management by comparing states that did versus did not expand Medicaid as part of the ACA
and seeks to understand the influence of SDH on these changes. the investigators will address
the following specific aims: Aim 1: Compare HTN incidence, prevalence of undiagnosed HTN, and
rates of HTN screening, in Medicaid expansion versus non-expansion states before and after
the ACA. Aim 2: Compare HTN treatment (e.g., medication use), and management (e.g., HTN
control, systolic and diastolic blood pressure change, risk factors related to HTN control)
in Medicaid expansion versus non-expansion states before and after the ACA. Aim 3: Assess the
extent to which rates of HTN incidence, screening, and treatment effectiveness among patients
who gained insurance versus those continuously insured or uninsured, pre-post ACA, are
moderated by individual-level SDH (e.g., race, ethnicity), in expansion states. Aim 4:
Explore the interaction between community-level SDH (e.g., neighborhood racial segregation
and deprivation) and HTN incidence, screening, treatment, and management among patients who
gained insurance relative to those who were continuously insured or uninsured, in expansion
states. The findings from this project will be extremely relevant to policy and practice,
informing further improvements in the US healthcare system to ensure access to healthcare for
vulnerable populations.

Inclusion Criteria:

- Patients in intervention and control states aged 19-64

Exclusion Criteria:

- Patients outside of age range 19-64