Abstract P309: Health-Harming Legal Needs Are Associated With Blood Pressure, Quality of Life, and Utilization
Authors: Ben King, Stephanie Sanchez, Daniel Medford, Winston Liaw, Luan Tran, Marina Arocha, Omolola E Adepoju, LeChauncy Woodard, Bruno Moscoso, Ishita Sharma
Journal: Circulation (2024)

Background: Health-harming legal needs (HHLNs) significantly contribute to stress and have been linked to chronic disease burden in low-income populations. Medical-legal partnerships (MLPs) target HHLNs by embedding legal services within clinics. The impact of HHLNs on chronic disease, quality of life, and utilization is uncertain. This study sought to determine whether presence of and the number of HHLNs is associated with high blood pressure, worse quality of life, and higher healthcare utilization rates. Method: This is a cross-sectional study of a MLP program involving a federally qualified health center and non-profit legal services organization. The evaluation included all individuals, 18 years old and above, who received care at the clinic and were screened for HHLNs. All patients were offered HHLN screening (23-items) between March 2021 and December 2022. Blood pressure status was measured by two approaches: 1) the presence of hypertension diagnostic codes or anti-hypertensive medication, 2) the most recent mean arterial pressure (MAP). Quality of life was assessed using the number of unhealthy physical or mental days in a month. Participants reported the number of urgent care, emergency department (ED), and hospital visits over the prior 12 months. Using an available case analysis approach and logistic regression, we assessed the association between the total number and individual HHLNs and the presence of hypertension diagnoses or medications. For MAP, unhealthy days, and utilization, we used linear and negative binomial regression models. Results: Four hundred seventy-five participants completed surveys. Nearly half (198; 41.7%) reported at least one HHLN. There were no differences in HHLN reported across demographic groups. The number of HHLNs was associated with having a diagnosis of or medication for hypertension (OR=1.08, p=0.049) but was not associated with MAP (coeff=0.098, p=0.596). The number of HHLNs was similarly associated with more unhealthy physical (coeff=0.150, p=0.015) and mental days (coeff=0.157, p=0.002). More HHLNs were also associated with higher urgent care (coeff=0.252, p&lt;0.001) and ED utilization (coeff=0.181, p=0.014) but not hospitalizations (coeff=0.099, p=0.150). Hypertension was found to be associated with individual HHLN: income issues, losing health insurance, immigration applications, food insecurity and housing instability (all p&lt;0.05) over other needs. Several more HHLNs were associated with physical and mentally healthy days in past month (all p&lt;0.05). Multiple relationships persisted after controlling for demographics. Conclusions: The number of HHLNs and several specific legal needs are associated with hypertension, higher unhealthy physical and mental days, and higher urgent care and emergency department utilization. In future studies, we will study the longitudinal outcomes of HHLNs that are addressed by the MLP.