Role of Health Insurance and Neighborhood-level Social Deprivation on Hypertension Control Following the Affordable Care Act Health Insurance Opportunities

Objectives: To understand if neighborhood-level social deprivation moderates the association between gaining health insurance and improved hypertension control.

Methods: We used electronic health record (EHR) data from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) clinical data research network from five states that expanded Medicaid eligibility (CA, OH, OR, WA, WI). We include patients with hypertension aged 19-64. Controlled hypertension was assessed for four groups pre-(1/1/2012-12/31/2013) to post-(1/1/2014-12/31/2017) Affordable Care Act (ACA) Medicaid expansion: (1) newly insured, (2) continuously insured, (3) discontinuously insured, and (4) continuously uninsured. We also used Social Deprivation Index score to derive predicted probability of controlled hypertension using logistic mixed effects.

Results: N = 28,485 patients. All groups experienced improved hypertension control: the newly insured saw a greater increase than the other groups (8.6% vs. 0.9% for the continuously uninsured, 1.3% for the continuously and 3.0% for the discontinuously insured). The likelihood of hypertension control rose more for the newly insured (vs. the other insurance groups) for patients living in the most deprived neighborhoods (16% from pre- to post-ACA).

Conclusions: Gaining health insurance was related to hypertension control; individuals living in the most disadvantaged communities experienced the greatest benefit.

Policy Implications: Ensuring health insurance access is important for cardiovascular health, especially among disadvantaged communities.