J-030 RELATIONSHIP BETWEEN UNEMPLOYMENT RATE AND INCIDENCE OF HYPERTENSION AND THE NUMBER OF OUTPATIENT AND INPATIENT VISITS BETWEEN 2001 AND 2005

Abstract

Background Social economic status has been found associated with cardiovascular diseases. This study investigates the effects of unemployment rate on the incidence of hypertension, and the outpatient and inpatient visits due to hypertension. Methods Data were from the 2001 Taiwan National Health Interview Survey (NHIS). With the informed consent of NHIS respondents, we obtained their medical utilization from National Health Insurance (NHI) claims data. Then the biomarkers of NHIS respondents were collected from the Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH). County unemployment rate was used as an area-level socioeconomic variable. Hypertension was defined according to ICD-9-CM: 401–405. Multilevel model for survival analysis with a time-dependent covariate was used. Multilevel logistic regression and multilevel Poisson regression were performed to estimate effects on the outpatient and inpatient visits. Results There were 5,361 individuals included in the analysis. During 2001 to 2005, the unemployment rate increased the chance of hypertension of females living in metropolitan areas (hazard ratio (HR):1.21, 95%CI:1.01∼1.46) given other risk factors. Unemployment rate reduced the utilization of health care services, such as outpatient or inpatient services. After controlling for other factors, the rate ratio of unemployment rate (RR) was 0.81 (95%CI:0.71∼0.93) and 0.77 (95%CI:0.67∼0.88) for males and females respectively. Older age, living with spouse, with larger BMI, higher values of triglycerides or waist-to-hip ration increased the chance of utilization of health care due to hypertension. Similar pattern was found in number of visits. Conclusion After controlling age, education, marital status, smoking, alcohol drinking, monthly income, body mass index, triglycerides and waist to hip ratio, unemployment rate increased the incidence of hypertension in females living in metropolitan areas. However, the unemployment rate decreased the utilization of health care systems for hypertension.