Date of Award

5-2024

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Laura L. Hayman

Second Advisor

Ling Shi

Third Advisor

Eileen Stuart-Shor, Elizabeth Howard

Abstract

Hypertension (HTN) is a highly prevalent chronic health condition and a leading cause of premature death in American adults. Preventing and controlling HTN at younger ages is necessary to prevent long term health problems. Research related to HTN outcomes and age frequently centers on older adults and less is known on the determinants of HTN in working aged adults. Serial cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES) (2011 to 2020) was performed. The primary objectives of the study were to examine and provide contemporary estimates of HTN outcomes in working age adults (aged 20 to 64) including assessment of: (1) trends in HTN awareness, treatment and control across NHANES cycles; (2) the socio-ecological factors associated with HTN awareness, treatment and control; (3) examination of the moderating effect of age on the association between HTN awareness and treatment; and (4) assessment of the mediating effect of HTN awareness on the relationship between age and HTN treatment. The prevalence of HTN awareness was stable over time in the total sample from 57.5% in 2011-2012 to 56.9% in 2017-2020 (ptrend=0.082). The prevalence of HTN treatment was also stable across consecutive cycles of NHANES with a prevalence of 81.7% in 2011-2012 and a prevalence of 81.2% in 2017-2020 (ptrend=0.838). There was also no statistically significant trend in HTN control in the overall population over time (ptrend=0.056) but a statistically significant negative trend was noted in HTN control in those reporting HTN treatment (prevalence difference: -1.8, ptrend=0.031). Significant trends were noted by subgroup. Women had a negative decline in HTN awareness and HTN treatment over time (ptrend =0.006 and ptrend < 0.001, respectively). A decline in HTN treatment was also noted in men (ptrend < 0.001). Notably, a negative trend was also observed in younger adults (aged 20 to 39) in HTN treatment and HTN control in those reporting HTN treatment (ptrend =0.009 and ptrend =0.005, respectively). Compared to adults aged 60 to 64, this younger age group was less likely to report HTN awareness (adjusted Prevalence Ratio (aPR)=0.55 [95% Confidence Interval (CI), 0.49-0.60]), HTN treatment (aPR=0.82 [95% CI, 0.76-0.88]), and HTN control (aPR=0.27 [95%CI, 0.21-0.35]). Men were less likely to have HTN control compared to women (aPR=0.86 [95% CI, 0.75-0.98]). Other notable findings include that participants reporting availability of a usual source of care were 64% more likely to report HTN awareness (aPR=1.64 [95% CI, 1.44-1.86]), 83% more likely to report HTN treatment (aPR=1.83 [95% CI, 1.56-2.14]) and were almost three times as likely to have HTN control (aPR=2.93 [95% CI, 1.96-4.40]), compared to participants with no usual source of care. The relationship between HTN awareness and HTN treatment was modified by age on the additive scale for younger adults both with HTN awareness (aPR 0.81, [95% CI 0.69-0.95]) and without HTN awareness (aPR 0.86, 95% CI 0.74-0.99]) compared to participants aged 60 to 64 with HTN awareness. In conclusion, HTN awareness, treatment and control have declined in certain subgroups and HTN metrics differ substantially by age and sex. Access to a usual source of care was highly correlated with a higher prevalence of HTN treatment and control. Lastly, on the additive scale, age moderated the relationship between HTN awareness and treatment in younger adults. These findings highlight the need to improve HTN awareness, treatment and control in younger adults and men, and to arrest the decline in HTN awareness and treatment in women. Further research is necessary to evaluate the upstream factors contributing to the decline in the awareness, treatment and control of HTN and the lack of responsiveness to HTN awareness in young adults.

Comments

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