Send to

Choose Destination
J Womens Health (Larchmt). 2017 Dec;26(12):1292-1301. doi: 10.1089/jwh.2016.6308. Epub 2017 Jul 6.

Effects of Health Insurance Interruption on Loss of Hypertension Control in Women With and Women Without HIV.

Author information

1 Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
2 Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
3 Department of Epidemiology and Population Health, Albert Einstein College of Medicine , Bronx, New York.
4 Department of Medicine, Cook County Health and Hospital System and Rush University , Chicago, Illinois.
5 Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University , Atlanta, Georgia .
6 Division of Infectious Diseases, Department of Medicine, University of Miami School of Medicine , Miami, Florida.
7 Department of Medicine, University of California , San Francisco, San Francisco, California.
8 Department of Biomedical Materials Science, School of Dentistry, University of Mississippi Medical Center , Jackson, Mississippi.
9 Department of Family Medicine, Georgetown University Medical Center , Washington, District of Columbia.
10 Department of Preventive Medicine, Keck School of Medicine, University of Southern California , Los Angeles, California.
11 Department of Community Health Sciences, School of Public Health, State University of New York (SUNY) Downstate Medical Center , Brooklyn, New York.



Among low-income women with and without HIV, it is a priority to reduce age-related comorbidities, including hypertension and its sequelae. Because consistent health insurance access has been identified as an important factor in controlling many chronic diseases, we estimated the effects of coverage interruption on loss of hypertension control in a cohort of women in the United States.


We analyzed prospective, longitudinal data from the Women's Interagency HIV Study. HIV-infected and HIV-uninfected women were included between 2005 and 2014 when they reported health insurance at consecutive biannual visits and had controlled hypertension, and were followed for any insurance break and loss of hypertension control. We estimated hazard ratios (HRs) by Cox proportional hazards regression with inverse-probability-of-treatment-and censoring weights (marginal structural models), and plotted the cumulative incidence of hypertension control loss.


Among 890 HIV-infected women, the weighted HR for hypertension control loss comparing health insurance interruption to uninterrupted coverage was 1.37 (95% confidence interval [CI], 0.99-1.91). Inclusion of AIDS Drug Assistance Program (ADAP) participation with health insurance modestly increased the HR (1.47; 95% CI, 1.04-2.07). Analysis of 272 HIV-uninfected women yielded a similar HR (1.39; 95% CI, 0.88-2.21). Additionally, there were indications of uninterrupted coverage having a protective effect on hypertension when compared with the natural course in HIV-infected (HR, 0.82; 95% CI, 0.61-1.11) and HIV-uninfected (HR, 0.78; 95% CI, 0.52-1.19) women.


This study provides evidence that health insurance continuity promotes hypertension control in key populations. Interventions that ensure coverage stability and ADAP access should be a policy priority.


HIV/AIDS; health insurance; hypertension; women

Comment in

[Indexed for MEDLINE]
Free PMC Article

Publication type, MeSH terms, Substances, Grant support

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center