Evaluating the Impact of Discrimination and Isolation in Patients with Hypertension in the Predicting Risk and Investigating Outcomes Using Patient-Reported Individual and Community-Level Data (PRIORITY) Cohort

Background: Hypertension (HTN) disproportionately affects socially marginalized groups; social determinants of health (SDOH), including discrimination, are known to contribute to poor HTN outcomes.This study explored relationships among experiences of discrimination, social isolation, and other key SDOH factors. Methods:We analyzed baseline structured interview data for enrolled patients with HTN from PRIORITY, a prospective cohort study of randomly selected adult emergency department patients with chronic illnesses.We examined validated measures of social isolation, experiences of discrimination and other SDOH.Each of four SDOH factors (financial strain, housing insecurity, employment status, social isolation) was modeled in a separate logistic regression with selfreported discrimination as the outcome.Interaction effects with social isolation were also explored to assess potential effect modification.Results: Participants (n = 255) were 57% female; 38% Latine, 46% Black, 9% White, with mean age of 59 years.Those reporting housing insecurity had significantly higher odds of experiencing discrimination compared to those without such concerns (OR: 2.0; 95% CI:1.1-3.7).Similarly, those experiencing financial strain had greater odds of reporting discrimination (OR: 2.4; 95% CI: 1.5-4.1).Feelings of loneliness or social isolation were also associated with increased odds of discrimination (OR: 2.2; 95% CI: 1.1-4.6).An interaction analysis revealed that those who were both socially isolated and un/underemployed had substantially higher odds of reporting discrimination (OR: 10.3; 95% CI: 1.42-215.0)compared to those without both conditions. Conclusion:Experiences of discrimination are associated with multiple social risks in patients with HTN, and isolation may intensify these associations.These findings support the need for equity-centered care strategies to improve health outcomes.