Abstract 16499: Social Determinants and Racial Disparities Among Hospitalized Individuals With Hypertensive Crisis; a Retrospective Population-Based Cohort Analysis

Abstract

Introduction: Hypertensive crisis (HC) encompasses hypertensive emergencies (HE) and urgencies (HU). Recent literature on HC's social determinants (SD) and racial disparities (RD) of the inpatient population is scarce. We aimed to examine these factors. Hypothesis: We hypothesized that there would be variations in the RD and SD of hospitalized individuals with HC. Methods: A retrospective analysis of the 2016-2020 National Inpatient Sample was conducted, and all hospitalizations for HC were identified with their ICD-10 codes. A multivariate logistic regression analysis was performed to account for confounders and estimate the probability of outcomes. Our primary outcomes were SDs of HC. Secondary outcomes were myocardial infarction (MI), stroke, acute kidney injury (AKI), and transient ischemic attack (TIA). Results: Of the 32,355,827 of all hospitalizations, 2.4% (762,185) had a diagnosis of HC (48.5% (369735) HU, 37.3% (284350) HE, and 14.2% (108100) ‘HC unspecified’), with 49.8% (285,634) Caucasians, 34% (188,255) Blacks, 11.2% (63,952) Hispanics and 2.8% (16,173) were Asians. When stratified by age, the Black population was the youngest of all the races; 57.6 years ±15.6 vs. 67.9 years ±15.5 Caucasians, vs. 60.5 years ±17 Hispanics, vs. 65.2 years ±17 Asians, p<0.0001. The minority populations were more likely than the Caucasians to be diagnosed with HCs; Blacks 2.7 (2.6-2.9), Hispanics 1.2 (1.2-1.3), and Asians 1.4 (1.3-1.5),(p<0.0001, all). Furthermore, being male 1.1 (1.09-1.2, p<0.0001), those with ‘self-pay’ insurance type 1.02 (1.01-1.03, p<0.0001), and those in the <25th percentile of median household income 1.3 (1.2-1.3, p<0.0001), were more likely to be diagnosed with HCs.The Black population had the highest likelihood of end-organ damage; MI 2.7 (2.6-2.9), Stroke 3.2 (3.1-3.4), AKI 2.4 (2.2-2.5), and TIA 2.8 (2.7-3.0), (p<0.0001, all), compared to their Caucasian counterpart. Conclusions: Being of a minority population, male sex, low-income status, and uninsured were associated with a higher likelihood of hypertensive crisis. Blacks were the youngest and had the highest risk of end-organ damage. Targeted interventions and healthcare policies should be implemented to address these disparities and improve patient outcomes.