Association for Public Policy Analysis & Management

Background: Hypertension is a top cause of preventable burden of disease in the United States. About 15% of patients with hypertension are unaware of their condition and 25% were untreated in 2011-2014, with larger gaps observed in younger age groups. Implementation of the Affordable Care Act was associated with increases in health insurance coverage and use of health care among adults under 65 years of age, but the association of ACA implementation with biomarker-measured health is unknown.

Research Goal: To examine changes in awareness, treatment, and control of hypertension before vs. after full implementation of the Affordable Care in 2014 across multiple age groups.

Data and Methods: We pair newly released nationally representative data on blood pressure from the National Health and Nutrition Examination Survey (NHANES) for the 2015-2016 biannual cycle with data from previous years to track awareness, treatment and control of hypertension over 2005-2016. We use multivariate regressions with age-by-time interaction terms to assess differential changes by age group during 2014-2016, and adjust for temporal trends and patient level race and ethnicity, gender, and education. Following previous literature, we exclude participants who are currently pregnant.

Results: In 2009-2012, 38% of adults aged 18-39 with hypertension were unaware, compared with 15% and 12% of adults aged 40-64 and 65+, respectively. Awareness of hypertension did not significantly change after full implementation of the Affordable Care Act among the two older age groups but increased by 5% among adults under age 40. We found no significant changes in treatment or control of prevalent hypertension during 2014-2016 after adjusting for demographic characteristics.

Discussion: Our data are consistent with increases in timely awareness of hypertension after full implementation of the Affordable Care Act among younger adults, the group that was previously least likely to be aware of their prevalent hypertension. Because uncontrolled hypertension carries a two-fold higher risk of vascular mortality for adults at ages 40-49 years than ages 80-89, any future improvements in control that result from this increased awareness would be clinically important.

Additional Note: Although not all biomarker data are yet available for the NHANES survey, measures of blood pressure have been released. By the conference, we will be able to compare our findings for blood pressure with findings for diabetes and high cholesterol.