title: Small-area Variation in Hypertension Prevalence among Black and White Medicaid Enrollees.
abstract: OBJECTIVE
  To examine within-state geographic heterogeneity in hypertension prevalence and evaluate associations between hypertension prevalence and small-area contextual characteristics for Black and White South Carolina Medicaid enrollees in urban vs rural areas.
  
  
  METHODS
  Ecological.
  
  
  METHODS
  South Carolina, United States.
  
  
  METHODS
  Hypertension prevalence.
  
  
  METHODS
  Data representing adult South Carolina Medicaid recipients enrolled in fiscal year 2013 (N=409,907) and ZIP Code Tabulation Area (ZCTA)-level contextual measures (racial segregation, rurality, poverty, educational attainment, unemployment and primary care physician adequacy) were linked in a spatially referenced database. Optimized Getis-Ord hotspot mapping was used to visualize geographic clustering of hypertension prevalence. Spatial regression was performed to examine the association between hypertension prevalence and small-area contextual indicators.
  
  
  RESULTS
  Significant (alpha=.05) hotspot spatial clustering patterns were similar for Blacks and Whites. Black isolation was significantly associated with hypertension among Blacks and Whites in both urban (Black, b=1.34, P<.01; White, b=.66, P<.01) and rural settings (Black, b=.71, P=.02; White, b=.70, P<.01). Primary care physician adequacy was associated with hypertension among urban Blacks (b=-2.14, P<.01) and Whites (b=-1.74, P<.01).
  
  
  CONCLUSIONS
  The significant geographic overlap of hypertension prevalence hotspots for Black and White Medicaid enrollees provides an opportunity for targeted health intervention. Provider adequacy findings suggest the value of ACA network adequacy standards for Medicaid managed care plans in ensuring health care accessibility for persons with hypertension and related chronic conditions.
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina.
authors.forename: Kellee
authors.initials: K
authors.lastname: White
authors.affiliation: Division of Medicaid Policy Research Institute for Families in Society, University of South Carolina.
authors.forename: John E
authors.initials: JE
authors.lastname: Stewart
authors.affiliation: Division of Medicaid Policy Research Institute for Families in Society, University of South Carolina.
authors.forename: Ana
authors.initials: A
authors.lastname: Lòpez-DeFede
authors.affiliation: Division of Medicaid Policy Research Institute for Families in Society, University of South Carolina.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Wilkerson
mesh_terms: D000328:Adult; D044383:Black People / Q000706:statistics & numerical data*; D002908:Chronic Disease; D005260:Female; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D011203:Poverty; D015995:Prevalence; D017062:Small-Area Analysis; D012934:Social Isolation; D013022:South Carolina; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American
keywords: Hotspot Mapping; Hypertension; Medicaid; Residential Segregation; Rural and Urban; Small-area Variation