Disparities in diagnosis and management of hypertension by incarceration status for patients receiving care in the emergency department.

BACKGROUND

Incarcerated individuals have increased rates of chronic diseases, including cardiovascular disease, but often receive no regular medical care. The primary objectives of this study were to examine the associations between incarceration and the presence of undiagnosed or uncontrolled hypertension in a patient population treated in the emergency department (ED) of a large, urban, safety-net hospital. We hypothesized that incarcerated patients would have higher odds of undiagnosed and uncontrolled hypertension compared to non-incarcerated patients.

METHODS

This cross-sectional analysis identified all adult patients ≥25 years presenting to the Boston Medical Center ED. Multivariable generalized estimating equation logistic regression modeling was conducted to estimate odds ratios (ORs) and 95% confidence intervals (95%CI) to evaluate associations between incarceration status and undiagnosed/uncontrolled hypertension.

RESULTS

Of 352,772 ED visits among 130,268 patients, 3216 visits (1%) were among incarcerated patients. Compared to non-incarcerated patients, incarcerated patients had 14% higher odds of hypertension (OR = 1.14, 95%CI = 1.03-1.27, p = 0.01) and 56% higher odds of undiagnosed hypertension (OR = 1.56, 95%CI = 1.41-1.73, p < 0.0001). The prevalence of undiagnosed hypertension was higher for incarcerated patients (24.1% versus 15.4%) among all age groups, but the difference was greatest for the oldest patients aged 65 years or older (40.1% versus 17.0%). Among patients with a hypertension diagnosis and prescription medication for high blood pressure, incarcerated patients were at 64% higher odds of having uncontrolled high blood pressure (OR = 1.64, 95%CI = 1.21-2.21, p = 0.001). Despite these health disparities, incarcerated patients had equal odds of the ED visit resulting in a new prescription for hypertension medication.

CONCLUSION

Incarceration has profound impacts on the health of inmates. Interaction with emergency department clinicians provides an opportunity for chronic disease diagnosis and management in a population with limited healthcare access.