76 - Association of Public Insurance with Blood Pressure Severity and Initial Management in Youth Referred for Hypertensive Disorders: a SUPERHERO Interim Analysis

Poster Number: 76
Publication Number: 76.324

Estefania G. Narvaez, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Waxhaw, NC, United States; Victoria Giammattei, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Caroline B. Lucas, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Jack Weaver, Levine Children's Hospital, Charlotte, NC, United States; Andrew M. South, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States

Background: Youth with hypertension develop short-term and long-term cardiovascular complications. Those with health disparities may be at greater risk and may not be able to access the same level of care as those with private insurance. The specific role of health disparities and their proxies, such as insurance status, remain unclear.

Objective: Investigate if youth referred for hypertensive disorders who have public insurance have more severe blood pressure (BP), undergo less testing for target organ damage, and receive less prescriptions for antihypertensive medications.

Design/Methods: Interim analysis of baseline data from two centers from Phase 1.1 of The Study of the Epidemiology of Pediatric Hypertension (SUPERHERO) Registry, a multicenter retrospective cohort. Inclusion criteria were initial visit for hypertensive disorder (identified by ICD-10 code) between 1/1/2016 and 6/30/2021. Exclusion criteria were ICD-10 code-identified kidney failure on dialysis, kidney transplant, or pregnancy at the initial visit. We recorded demographics including binary insurance status (public vs. private or self-pay) and our outcomes BP and related z-scores, BP classification per AAP Clinical Practice Guideline criteria, urine albumin or protein orders, echocardiogram orders, and antihypertensive medication orders. We estimated the associations between public insurance and the outcomes using unadjusted generalized linear models.

Results: Of the 2,655 participants, median age was 14.2 [IQR 10.7, 16.3], 62.6% were male, 49.2% were White or Caucasian, 28.6% were Black or African American, 17.8% were Hispanic or Latino, and 65.0% had public insurance (Table 1). On unadjusted analysis, public insurance was associated with higher diastolic BP z-score in participants < 13 years old (β 0.14, 95% CL 0.02 to 0.27), but was not associated with other measures of BP severity, testing orders, or prescriptions.Conclusion(s): We did not observe statistically significant differences between insurance status and BP severity and initial management at the index clinic visit in youth referred for hypertensive disorders, except for a higher diastolic BP z-score. Ongoing steps in SUPERHERO include data collection from other centers, validation with random chart review, and adjustment for confounding factors and other types of bias in multivariable models.
Table 1. Baseline Demographics and Clinical Characteristics of Youth Referred for Hypertensive Disorders by Insurance StatusN (%), mean (SD), median [IQR]. *Between-group comparison p < 0.05 by chi-square test, Fisher exact test, t-test, or Wilcoxon rank-sum test. BMI, body mass index.
Table 2. Blood Pressure Severity and Urine Protein/Albumin, Echocardiogram, and Antihypertensive Medication Orders at Baseline by Insurance Status in Youth Referred for Hypertensive DisordersN (%), mean (SD), median [IQR]. *Between-group comparison p < 0.05 by Wilcoxon rank-sum test; (a) met high BP criteria but unable to further classify. BP, blood pressure.