The determinants of antihypertensive use and expenditure in patients with hypertension in the USA

Abstract

Objectives The objective of this study was to examine factors associated with antihypertensive use and expenditures in patients with hypertension using national representative data from the USA. Methods We used two household component data files from the 2009 Medical Expenditure Panel Survey (MEPS): the 2009 full-year consolidated file and prescribed medicine file. We identified individuals aged 18 years and older who had been diagnosed with hypertension. A two-part multivariable regression model was used to evaluate factors associated with (1) the likelihood of patients obtaining an antihypertensive and (2) the determinants of total amount spent for antihypertensive drug therapy. Key findings Approximately 30% of the total adult population in the MEPS reported having been diagnosed with hypertension while only about 56% of these patients reported receiving antihypertensive therapy in 2009. Patients with higher family income, health insurance and poor health status had a higher likelihood of obtaining an antihypertensive and also a higher total amount spent for antihypertensive drug therapy. Having either public or private health insurance and residing in the Northeast or South region of the USA appear to be most strongly associated with antihypertensive use. Conclusions Using a national representative dataset, and a two-part regression model, this study identified factors associated with antihypertensive use and expenditure. The findings may aid policy makers and physicians to identify groups of patients with hypertension who may be untreated or undertreated, and help understand the drivers of antihypertensive costs among the treated.