title: The Burden of Obesity, Elevated Blood Pressure, and Diabetes in Uninsured and Underinsured Adolescents.
abstract: Obesity, elevated blood pressure (BP), and diabetes mellitus are rising among the general U.S. adolescent population, but prevalence estimates are not available for uninsured or Medicaid populations.
  
  
  
  This retrospective epidemiological study extracted 155,139 electronic medical records collected between 1998 and 2012 on patients aged 10-19 years, from a clinical population predominantly uninsured or insured by Medicaid. Age, sex, race, height, weight, BP, and insurance type were captured at first clinic visit. Classifications included obesity (≥95th body mass index percentile), elevated BP (≥90th percentile), and diabetes mellitus (ICD-9-250.xx).
  
  
  
  Among the 26,696 patients with complete data at first clinic visit, 24.4% were classified as obese and 39.5% had elevated BP. In logistic regression analyses, odds of obesity were significantly higher among uninsured versus commercially insured patients (odds ratio [OR]: 1.1 [95% confidence interval: 1.0-1.2]) and girls (OR: 1.3 [1.2-1.4]), but lower among older adolescents (for 15-17 years, OR: 0.7 [0.6-0.7]; for 18-19 years, OR: 0.7 [0.7-0.8]). Odds of elevated BP were significantly higher among Medicaid (OR: 1.1 [1.0-1.2]) and uninsured (OR: 1.2 [1.1-1.4]) versus commercially insured patients, but lower among African American versus White youth (OR: 0.9 [0.8-0.9]). Prevalence of type 1 diabetes was 1.46 per 1000 and prevalence of type 2 diabetes was 1.68 per 1000, with both occurring more often in girls versus boys and in Whites versus African Americans.
  
  
  
  In this low-income clinical population, prevalence of obesity and elevated BP were higher than national estimates. The provision of preventive healthcare to all Medicaid and uninsured youth should remain a priority.
authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, Louisiana.
authors.forename: Amanda E
authors.initials: AE
authors.lastname: Staiano
authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, Louisiana.
authors.forename: Madeline
authors.initials: M
authors.lastname: Morrell
authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, Louisiana.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Hsia
authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, Louisiana.
authors.forename: Gang
authors.initials: G
authors.lastname: Hu
authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, Louisiana.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Katzmarzyk
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology*; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000453:epidemiology*; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D009765:Obesity / Q000191:economics / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012923:Social Class; D014481:United States; D055815:Young Adult
keywords: electronic medical record; hypertension; overweight; pediatrics; prevalence; type 2 diabetes mellitus