Examining the Impact, Pathways, and Cost of County-Level Drivers of Hypertension Rates among US Adults

Johns Hopkins University, Baltimore MD

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Linked publications & trials

Abstract

Subpopulations within the US have disproportionate hypertension (high blood pressure; HBP) rates – differences that have persisted for decades and at the highest cost to society of all cardiovascular conditions. The underlying cause of these differences is unknown, and previous studies have mostly focused on individual-level behaviors, stressors, and physiologic risk factors leaving a missed opportunity to uncover and address the underlying causes of these disproportionate rates. Factors at both the individual-level and area-level may play a role; thus, to fully address hypertension in our nation, we must investigate the pathways through which both individual-level and area-level factors influence HBP risk factors and rates. Given that many key decisions about health and healthcare services are made at the level of the county-seat, county-level factors are critical to assess. Using a novel 5-domain measure of county-level social conditions, our previous cross-sectional studies have demonstrated that our index is associated with higher BMI, one behavioral risk factor for HBP; however, this work has left gaps in understanding how county-level factors influence other risk factors for HBP and HBP rates. Our goal is to conduct a multi-level national study to investigate associations between our novel multi-dimensional measure of county-level social and economic factors and: physiologic, behavioral, and structural risk factors for HBP (Aim 1), HBP incidence, prevalence, and severity (Aim 2), and how much counties could save in HBP healthcare costs if county-level social and economic conditions were modified (Aim 3). We leverage pre-existing resources that are uniquely available to us: (a) our published county-level index, (b) US News & World Report hospital rankings of healthcare quality, and (c) longitudinal behavioral and biomarker HBP data from 30,239 adults across the US in the REGARDS cohort study. We expand beyond previous studies by using a multi-domain measure of county-level factors, across urban and rural areas, applying it to longitudinal health data that allows us to assess exposure to these factors at multiple times in the lifecourse, and quantifying how much social and economic conditions cost counties in HBP healthcare spending if they go unmitigated. We will translate our findings into policy briefs targeted toward county-level executives in the US. Our team of experts in cardiovascular disease (CVD), social and clinical epidemiology, and health economics, with representation from REGARDS, two Hopkins Centers focused on vulnerable populations, Hopkins’ CVD Epidemiology, and former county leaders, are well-equipped to execute this New Investigator application. Our results will offer evidence of how county-level factors influence HBP, with the potential to build support for county-level policy decisions that can ultimately reduce HBP rates.