Should patients with hypertension be screened for psychological distress?

Abstract

disparities exist across racial and age groups. We hypothesized that rate of wellness assessment indexed by fasting blood sugar and blood lipid levels varied across race and age among individuals with hypertension, regardless of the status of their insurance coverage. Methods: To test our hypotheses, we used the 2010-2013 NHIS dataset. Hypertension was self-reported. Results: Of the sample, 52% were female; mean age ( SEM) was 59.5 0.05 years and mean BMI was 29.5 0.02 kg/m2. Analysis also showed 74% were white; 20%, black; and 4%, Asian. Ten percent reported no insurance coverage. Chi square analysis showed that there were 9% non-insured whites, 13% non-insured blacks, and 9% non-insured Asians (p< 0.01). The rate of non-coverage was 30% for very young adults (18-25 years), 23% for young adults (26-34 years), 15% formiddle age adults (35-64 years), and 1% for older adults ( 65 years) (p < 0.01). Among 18-25 years, assessment rates of fasting blood sugar level were 22.1% versus 35.5%, p<0.01; among 25-34 years, they were 25.1% versus 49.7%, p<0.01; among 35-64 years, they were 45.8% versus 68.0%, p<0.01; among those 65 years, they were 58.6% versus 71.2%, p<0.01. Similarly, lower rates of fasting blood lipid were noted for non-insured hypertensives across the age groups. Among 18-25 years, 32.5% versus 50.1%, p<0.01; among 25-34 years, they were 35.2% versus 66.2%, p<0.01; among 35-64 years, they were 58.1% versus 86.1%, p<0.01; among those 65 years, they were 73.1% versus 92.2%, p<0.01. Race-based wellness care contrasts between noninsured and insured hypertensives revealed that the rates of annual fasting blood sugar assessment rates were lower among the non-insured. Among Asians rates were (44.1% versus 68.3%, p<0.01); blacks (42.6% versus 66.4%, p<0.01); whites (40.6% versus 72.5%, p<0.01). The non-insured also had fewer assessment rates for fasting lipid. Among Asians rates were (57.2% versus 88.3%, p<0.01); blacks (61.7% versus 88.0%, p<0.01); whites (57.2% versus 87.3%%, p<0.01). Conclusion: Consistent with our hypotheses, individuals with hypertension had varying rates of wellness assessment for blood sugar and blood lipid levels. Results also suggested that the rates of health insurance coverage differed by individuals’ age group and race. Support: NIH (R01MD007716), NINDS (U54NS081765), and the NHLBI (K24HL111315).