Abstract 239: Receipt of Routine Health Care Among African American Adults With Diabetes and Hypertension: Results from The Jackson Heart Study
Authors: Smith Melvin L , Gjelsvik Annie , White Wendy , Wu Wen-Chih , Vivier Patrick , Trivedi Amal , Winters Karen 
Published: March 2022

Objectives:
African Americans (AA) have a high prevalence of chronic diseases including hypertension (HTN) and diabetes (DM). Routine care is necessary to prevent adverse affects of chronic diseases. Few studies have examined patterns of routine care among AA with chronic diseases. This study uses Jackson Heart Study (JHS), a large prospective cohort of AA adults, to understand patterns of routine healthcare among AA adults with HTN and DM.

Methods:
Using data collected at 1st (2000-2004) and 3rd visit (2009-2012), adults with HTN (n=2,668) and those with DM (n=949) were analyzed. Routine healthcare at visits 1 and 3 by participants self reports of whether or not they have seen a doctor or other health professional for a routine physical exam or general check-up when not sick or pregnant within the past year. Independent variables were self-reported insurance status (private/ public/private and public/none), income status (Poor/Lower-Middle/Upper-Middle/Affluent based on self-reported annual income, family size, year, and poverty levels for 2000-2004), gender (male/female), age (years), healthcare trust (yes/no), difficulty obtaining healthcare (yes/no), and health status (excellent/good/fair/poor). HTN classification (normal/pre-HTN/stage 1/stage 2), DM classification (normal/at risk/diabetic) was based on directly assessed clinic, lab values, and included those on anti medications, regardless of blood pressure and triglyceride control. Logistic regression was used to determine crude and adjusted odds ratios and adjusted cross-sectional odds ratios of having routine care at visits 1 and 3 for those with DM and those with HTN.

Findings:
Routine care was high for both those with HTN and those with DM at both visits 1 and 3 (78% and 86% for HTN and 80% 87% DM, respectively). For both groups of patients, poor trust in the health care system decreased odds of routine care at visit 1 (DM adjusted Odds Ratio (aOR) 0.53 (95% Confidence Interval (CI) 0.33, 0.86), HTN aOR 0.59 (95% CI 0.45, 0.77) and at visit 3 (DM aOR 0.31 (95% CI 0.14, 0.71), HTN aOR 0.56 (95% CI 0.38, 0.83). Among the HTN sample, those with stages 1 or 2 HTN at visit 1 decreased odds of routine care at both visit 1 (aOR 0.51 (95% CI 0.31, 0.83) and visit 3 (aOR 0.48 (95% CI 0.28, 0.84) and increased severity of HTN at visit 3 decreased odds of routine care at visit 3. For both groups of patients, men had statically significant lower odds of routine care than women at visit 1 and visit 3 and increased age was associated with increased routine care. Insurance status and income status were not significantly associated with routine care in any of the adjusted models.

Conclusions:
AA with HTN and DM have high rates of routine care regardless of insurance or socioeconomic status. Rates of routine care were associated with trust in the health care system and self-reported difficulty obtaining health care independent of insurance status or income.