Abstract 4360298: Examining associations of medical discrimination and the hypertension cascade among adults in the All of Us Research Program

Background: Hypertension (HTN) is the leading risk factor for cardiovascular disease. Medical discrimination (i.e., discrimination in healthcare settings) is linked to poor disease management and delayed care. However, the influence of medical discrimination on HTN awareness, treatment, and control remains understudied. We sought to examine the associations of medical discrimination with HTN outcomes. Hypotheses: We hypothesized that: (1) medical discrimination would be associated with higher odds of elevated office blood pressure (BP) in the full sample, and (2) that among those with elevated office BP, medical discrimination would be associated with lower odds of being aware of having elevated BP, current antihypertensive medication use, and having controlled BP. Methods: We analyzed cross-sectional data from the All of Us Research Program. Medical discrimination was assessed with the 7-item Discrimination in Medical Settings Survey (a = 0.85) with higher scores indicating greater medical discrimination. We first assessed the presence of elevated office BP (i.e., systolic BP ≥130 and/or diastolic BP ≥80 mm Hg). Among participants with elevated office BP, we assessed whether they were aware of having elevated BP, were currently taking antihypertensive medication, and if they had controlled BP (all dichotomous). We ran separate logistic regression models to examine the associations of medical discrimination with each outcome. Models were adjusted for demographics, insurance, healthcare utilization, and history of heart attack or stroke. Results: The sample included 29,811 adults (mean age 58.6±15.9 years), of whom 64% were women and 83% were White. Approximately 69% reported experiencing any medical discrimination and 35% met criteria for elevated office BP. Medical discrimination was associated with higher odds of elevated office BP (AOR 1.13, 95% CI = 1.03-1.24; p = 0.01) and lower odds of being aware of having elevated BP (AOR 0.85, 95% CI = 0.75-0.96 ; p = 0.01). Medical discrimination was not associated with current antihypertensive medication use or BP control. Conclusion: Medical discrimination was associated with greater odds of elevated office BP and lower odds of being aware of having elevated BP. Findings underscore the need for efforts aimed at reducing medical discrimination to improve awareness of elevated office BP. Researchers should examine mechanisms by which medical discrimination influences these HTN outcomes in diverse patient samples.