Health insurance type and control of hypertension among US women living with and without HIV infection in the women's interagency HIV study

Christina Ludema, Stephen R. Cole, Joseph J. Eron, G. Mark Holmes, Kathryn Anastos, Jennifer Cocohoba, Marge H. Cohen, Hannah L.F. Cooper, Elizabeth T. Golub, Seble Kassaye, Deborah Konkle-Parker, Lisa Metsch, Joel Milam, Tracey E. Wilson, Adaora A. Adimora

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)594-601
Number of pages8
JournalAmerican Journal of Hypertension
Volume30
Issue number6
DOIs
StatePublished - 2017

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Health Insurance
HIV Infections
HIV
Blood Pressure
Hypertension
Medicaid
Insurance Coverage
Insurance
Health Status
Numbers Needed To Treat
Selection Bias
Proportional Hazards Models
African Americans
Delivery of Health Care
Weights and Measures
Health

Keywords

  • Blood pressure
  • Health insurance
  • HIV
  • Hypertension
  • Women

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Health insurance type and control of hypertension among US women living with and without HIV infection in the women's interagency HIV study. / Ludema, Christina; Cole, Stephen R.; Eron, Joseph J.; Holmes, G. Mark; Anastos, Kathryn; Cocohoba, Jennifer; Cohen, Marge H.; Cooper, Hannah L.F.; Golub, Elizabeth T.; Kassaye, Seble; Konkle-Parker, Deborah; Metsch, Lisa; Milam, Joel; Wilson, Tracey E.; Adimora, Adaora A.

In: American Journal of Hypertension, Vol. 30, No. 6, 2017, p. 594-601.

Research output: Contribution to journalArticle

Ludema, C, Cole, SR, Eron, JJ, Holmes, GM, Anastos, K, Cocohoba, J, Cohen, MH, Cooper, HLF, Golub, ET, Kassaye, S, Konkle-Parker, D, Metsch, L, Milam, J, Wilson, TE & Adimora, AA 2017, 'Health insurance type and control of hypertension among US women living with and without HIV infection in the women's interagency HIV study', American Journal of Hypertension, vol. 30, no. 6, pp. 594-601. https://doi.org/10.1093/ajh/hpx015
Ludema, Christina ; Cole, Stephen R. ; Eron, Joseph J. ; Holmes, G. Mark ; Anastos, Kathryn ; Cocohoba, Jennifer ; Cohen, Marge H. ; Cooper, Hannah L.F. ; Golub, Elizabeth T. ; Kassaye, Seble ; Konkle-Parker, Deborah ; Metsch, Lisa ; Milam, Joel ; Wilson, Tracey E. ; Adimora, Adaora A. / Health insurance type and control of hypertension among US women living with and without HIV infection in the women's interagency HIV study. In: American Journal of Hypertension. 2017 ; Vol. 30, No. 6. pp. 594-601.
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AU - Ludema, Christina

AU - Cole, Stephen R.

AU - Eron, Joseph J.

AU - Holmes, G. Mark

AU - Anastos, Kathryn

AU - Cocohoba, Jennifer

AU - Cohen, Marge H.

AU - Cooper, Hannah L.F.

AU - Golub, Elizabeth T.

AU - Kassaye, Seble

AU - Konkle-Parker, Deborah

AU - Metsch, Lisa

AU - Milam, Joel

AU - Wilson, Tracey E.

AU - Adimora, Adaora A.

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N2 - 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.

AB - 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.

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