title: Are demographic characteristics, health care access and utilization, and comorbid conditions associated with hypertension among US adults?
abstract: BACKGROUND
  Little is known about the factors associated with hypertension awareness, treatment, and control. We examined the association of demographic and socioeconomic characteristics, risk factors, health care access and utilization, and hypertension awareness, treatment, and control.
  
  
  METHODS
  The National Health and Nutrition Examination Survey (NHANES) 1999-2004, a continuous, annual survey of the civilian non-institutionalized US population. The sample comprised 4,816 hypertensive persons aged 20+ years.
  
  
  RESULTS
  Adults > or =60 years were more likely to have uncontrolled hypertension compared with adults 40-59 years old (60-69 years old: odds ratio (OR) 1.69, confidence interval (CI) 1.31-2.17; 80+ years old: OR 3.56, CI 2.42-5.25, respectively). Compared to men, women were more likely to have uncontrolled hypertension (OR 1.29, CI 1.01-1.64). When compared with non-Hispanic whites, non-Hispanic blacks were more likely to have uncontrolled hypertension (OR 1.40, CI 1.10-1.79). Diabetes and Poverty Income Ratio (PIR) classification of <1 were associated with increased likelihood of uncontrolled hypertension (OR 2.69, CI 1.99-3.63; OR 1.68, CI 1.19-2.37; respectively). Persons without health insurance had higher odds of being untreated when compared with insured persons (OR 2.38, CI 1.71-3.32). Younger age (20-39 years), lack of risk factors for hypertension and less health care were associated with increased odds of being unaware of hypertension.
  
  
  CONCLUSIONS
  Uncontrolled hypertension is more likely among women, older persons (> or =60 years), non-Hispanic blacks, the poor, and diabetics. Hypertension awareness and treatment is lower among the young (20-39 years), the uninsured, individuals reporting fewer health risk factors, and adults with less exposure and utilization of health care.
authors.affiliation: National Center for Health Statistics, Division of Health and Nutrition Examination Surveys, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Hyattsville, Maryland, USA. yxo1@cdc.gov
authors.forename: Yechiam
authors.initials: Y
authors.lastname: Ostchega
authors.forename: Jeffery P
authors.initials: JP
authors.lastname: Hughes
authors.forename: Jacqueline D
authors.initials: JD
authors.lastname: Wright
authors.forename: Margaret A
authors.initials: MA
authors.lastname: McDowell
authors.forename: Tatiana
authors.initials: T
authors.lastname: Louis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006266:Health Education; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000628:therapy*; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D016017:Odds Ratio; D011203:Poverty / Q000706:statistics & numerical data; D012307:Risk Factors; D017678:Sex Distribution; D012923:Social Class; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American