Community Treatment Patterns for Pediatric Hypertension in Medicaid-insured Youth

Abstract

Little is known about at-risk youth in terms of hypertension (HTN) treatment. This study explored the community-based prevalence of pediatric hypertension treatments among Medicaid-insured youth. We examined clinician-reported diagnoses (CR-DX) and racial/ethnic disparities in outpatient antihypertensive (AHT) medication use, days of persistence of AHT use, inpatient hospitalizations, and emergency department (ED) visits. A cross-sectional design was used for this study, employing retrospective data from personal summary, medical, pharmacy, and inpatient administrative claims files for youth continuously enrolled in 11 states Medicaid programs in the year 2003. Multivariate logistic regression adjusted for covariates measured prevalence of CR-DX of HTN, dispensed AHTs, hospitalizations, and ED visits; and Cox proportional-hazards regression was used to analyze persistence of AHT use by racial/ethnic group. A total of 7,795,395 youth, < 18 years of age, were eligible for this study. Analysis included 7,782 youth (0.10%) with ≥ 2 CR-DX of HTN. Primary HTN was 13 times more common than secondary HTN (80% vs. 6%). African American youth had the greatest likelihood of diagnosed HTN compared to Caucasian youth (OR=1.27, p<0.0001). Approximately 46% of youth diagnosed with HTN and 0.32% of youth without diagnosed HTN had dispensed AHTs. No racial/ethnic disparities in treatment were observed: African American youth (OR=1.06, p=0.43) and Hispanic youth (OR=0.96, p=0.59) were as likely as Caucasian youth to be treated with an AHT medication following diagnosis of HTN. Among youth with diagnosed primary HTN, persistence on AHT therapy did not differ among racial/ethnic groups. Older youth, aged 10 to 14 years (HR=1.40, p=0.025) and those aged 15 to 17 years (HR=1.45, p=0.011) had significantly shorter persistence with AHT therapy. Youth eligible for Supplemental Security Income (SSI), i.e. those with disabilities, had longer persistence on AHT therapy (HR=0.79; p=0.013) than those in other eligibility groups. African American and Hispanic youth with HTN were as likely as Caucasian youth to have a hospitalization or ED utilization at any time. The findings from this study highlight specific subpopulations (i.e. African American, disabled, and older youth) needs in HTN treatment that warrant further research, to assure optimal community-based care.