Disparities in access to care among US adults with self-reported hypertension.
BACKGROUND
Hypertension is a major risk factor for cardiovascular disease. Access to care has been identified as a significant factor affecting hypertension treatment and control. We examined disparities in access to care among US adults with self-reported hypertension.


METHODS
Using Behavioral Risk Factor Surveillance System 2011 data, we identified US adults with self-reported hypertension. Access to care was assessed based on responses to questions about health insurance, having an identified personal doctor, and cost barriers to visiting a doctor. We assessed access to care by geographic location (ie, US state) and selected sociodemographic characteristics.


RESULTS
Overall, 159,947 eligible participants reported having hypertension. Among them, 19.1% had no health insurance, 18.1% had no personal doctor, and 23.6% could not visit a doctor because of cost. Among those with hypertension by state, age-standardized prevalence of no health insurance ranged from 6.3% in Hawaii to 28.1% in Texas. The prevalence of those without a personal doctor ranged from 9.2% in Massachusetts to 32.7% in Nevada, and the prevalence of cost barrier to visiting a doctor ranged from 10.8% in North Dakota to 35.1% in Tennessee. By sociodemographic characteristics, the prevalence with no health insurance was highest among those aged 18-44 years (25.9%), Hispanics (28.1%), those with less than a high school education (32.8%), and those with a household income of less than $25,000 (31.6%). Similar disparity patterns were noted for estimates of the other access-to-care variables.


CONCLUSIONS
Among US hypertensive adults, approximately 20% reported access-to-care challenges, with significant geographic and sociodemographic variations.
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. jfang@cdc.gov.
Jing
J
Fang
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Quanhe
Q
Yang
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Carma
C
Ayala
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Fleetwood
F
Loustalot
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D004522:Educational Status; D005260:Female; D017048:Health Care Costs; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000191:economics / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*; D007182:Income; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D015995:Prevalence; D044469:Racial Groups; D012111:Residence Characteristics; D012307:Risk Factors; D057566:Self Report; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
access to care; blood pressure; disparity; hypertension.