Abstract WP418: Insurance Status Influences Blood Pressure Control among Stroke Survivors in the United States

Abstract

BACKGROUND: Hypertension is the premier modifiable risk factor for stroke. After a stroke, poorly controlled blood pressure (BP) is associated with a higher risk of recurrent vascular events; however, less than half of stroke survivors in the US have BP in the normal range. Uninsured and under-insured adults generally have less access to recommended care and receive poorer quality of care, but it is unclear to what extent insurance status affects BP control after stroke. METHODS: We assessed BP control among adults (≥20 years) with a history of stroke who participated in the National Health and Nutrition Examination Surveys from 1999 through 2010. The relationship between insurance type and BP control (ideal: <120/80 mm Hg and good: <140/90 mm Hg) was evaluated using logistic regression before and after adjusting for age, sex, race, body mass index, household income, history of hypertension and major comorbidities, and NHANES cycle. RESULTS: Of an estimated 2,253,394 stroke survivors <65 years, 47% had private insurance, 19% were uninsured, 10% had Medicaid, 10% had Medicare, 8% had other government insurance, and 4% had Medicare and Medicaid. Among an estimated 2,927,596 stroke survivors aged ≥65 years, 38% had Medicare, 44% had Medicare and Medicaid, 8% had private insurance, and the remainder had Medicaid, other government insurance, or were uninsured. Overall, 28% of stroke survivors exhibited ideal BP control and 61% of stroke survivors had good BP control. Insurance type was not associated with ideal BP control. However, among stroke survivors <65 years, those with Medicaid were more likely than those who were uninsured to have good BP control (HR 2.41, 95% CI 0.87-6.68; p=0.09). Among stroke survivors ≥65 years, those with a combination of Medicare and private insurance had greater odds of good BP control compared to persons with Medicare insurance alone (HR 1.39, 95% CI 0.97-2.00, p=0.07). CONCLUSIONS: Depending on age and insurance type, uninsured or underinsured stroke survivors in the US tend to have lower odds of good BP control. Recent legislation to expand insurance coverage may help bridge these disparities, but intensified efforts aimed at enhancing clinician communication and promoting self-management among these patients may also be warranted.