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Am J Hypertens. 2017 Jun 1;30(6):594-601. doi: 10.1093/ajh/hpx015.

Health Insurance Type and Control of Hypertension Among US Women Living With and Without HIV Infection in the Women's Interagency HIV Study.

Author information

1
Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana, USA.
2
Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
3
Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
4
Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
5
Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, New York, New York, USA.
6
Department of Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, New York, New York, USA.
7
Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, California, USA.
8
Department of Medicine, Cook County Health and Hospital System, Chicago, Illinois, USA.
9
Department of Medicine, Rush University, Chicago, Illinois, USA.
10
Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
11
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
12
Division of Infectious Diseases and Travel Medicine, Department of Medicine, Georgetown University, Washington, District of Columbia, USA.
13
Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi, USA.
14
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA.
15
Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
16
Department of Community Health Sciences, School of Public Health, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA.

Abstract

BACKGROUND:

Health care access is an important determinant of health. We assessed the effect of health insurance status and type on blood pressure control among US women living with (WLWH) and without HIV.

METHODS:

We used longitudinal cohort data from the Women's Interagency HIV Study (WIHS). WIHS participants were included at their first study visit since 2001 with incident uncontrolled blood pressure (BP) (i.e., BP ≥140/90 and at which BP at the prior visit was controlled (i.e., <135/85). We assessed time to regained BP control using inverse Kaplan-Meier curves and Cox proportional hazard models. Confounding and selection bias were accounted for using inverse probability-of-exposure-and-censoring weights.

RESULTS:

Most of the 1,130 WLWH and 422 HIV-uninfected WIHS participants who had an elevated systolic or diastolic measurement were insured via Medicaid, were African-American, and had a yearly income ≤$12,000. Among participants living with HIV, comparing the uninsured to those with Medicaid yielded an 18-month BP control risk difference of 0.16 (95% CI: 0.10, 0.23). This translates into a number-needed-to-treat (or insure) of 6; to reduce the caseload of WLWH with uncontrolled BP by one case, five individuals without insurance would need to be insured via Medicaid. Blood pressure control was similar among WLWH with private insurance and Medicaid. There were no differences observed by health insurance status on 18-month risk of BP control among the HIV-uninfected participants.

CONCLUSIONS:

These results underscore the importance of health insurance for hypertension control-especially for people living with HIV.

KEYWORDS:

HIV; blood pressure; health insurance; hypertension; women.

PMID:
28407044
PMCID:
PMC5861569
DOI:
10.1093/ajh/hpx015
[Indexed for MEDLINE]
Free PMC Article

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