Association between Insurance Status and Hypertension Control among US Adults after Affordable Care Act Implementation

A BSTRACT Background: After the Affordable Care Act (ACA) implementation, insurance coverage rates increased, yet the proportion of US adults with hypertension (HTN) and controlled HTN decreased from 2009–2010 to 2017–2018. We analyzed the US adult nonelderly population with a HTN diagnosis from 2009–2010 to 2021–2023 to test how the association of insurance status with controlled HTN has changed over time. Methods: Our analysis used data from the National Health and Nutrition Examination Survey (NHANES) and included all survey cycles from 2009 to 2023 (except for 2019–2020 which was excluded due to a suspension of data collection resulting from the COVID-19 pandemic), and our analytic sample included all respondents with a completed interview between the ages of 18 and 64 years who received a HTN diagnosis from a doctor or other healthcare professional. Results: The weighted proportion of adults with controlled HTN increased in those with Medicaid from 2009–2010 to 2017–2018 (7%–16%), decreased in those with private insurance (69%–62%), increased in those with other forms of insurance (7%–13%), and peaked in 2011–2012 (19%) in the uninsured population. The prevalence of uncontrolled HTN increased overall from 2009–2010 to 2021–2023 (25%–29%). Uninsured adults (odds ratio [OR]: 1.58; 95% confidence interval [CI]: 1.26–1.97; P < 0.001) were more likely to have uncontrolled HTN compared to adults with private insurance, and the NHANES cycle itself was associated with uncontrolled HTN (OR: 1.06; 95% CI: 1.02–1.11; P = 0.009). However, after including interaction terms between insurance status and NHANES cycle, there was no association between uncontrolled HTN and insurance status. Conclusion: The analysis found no evidence, suggesting that the association between insurance status and uncontrolled HTN has changed over time since ACA implementation after including interaction terms between insurance status and the earliest NHANES cycle.