Hypertension going untreated in U.S. Hispanic community, study shows

The study, "Prevalence of hypertension, awareness, treatment and control in the Hispanic Community," led by Dr. Paul D. Sorlie of the National Heart, Lung, and Blood Institute (NHLBI), sampled 16,400 individuals, making it one of the largest and most rigorous health studies of the Hispanic community. Hispanics are currently the largest minority group within the US population. The results show that while the prevalence of hypertension in the Hispanic community is nearly equal to that of non-Hispanic whites, diagnosis of the disease is much lower, as is general awareness of its symptoms and treatment options.

"This is a landmark study," says Dr. Michael Alderman, Editor-in-Chief of AJH. "This is the first comprehensive data on the prevalence and awareness of hypertension within the US Hispanic community that also includes all of its diverse subgroups." Prevention and control of hypertension are essential components for reducing the burden of cardiovascular disease. As such, the study offers important insights into new avenues for improving the health care of the United States' rapidly growing Hispanic population. Sorlie, et al. contend that the availability of health insurance plays a critical factor in the outcomes measured in their study, as the Hispanic community is the least insured minority group in the US.

"Though the presence of hypertension in the Hispanic community is nearly equal that of non-Hispanic whites, awareness and diagnosis lag significantly behind, particularly in those individuals without health insurance," says Dr. Sorlie. "Given the relative ease of identifying hypertension and the availability of low cost medications, enabling better access to diagnostic and treatment services should be prioritized to reduce the burden of cardiovascular disease on Hispanic populations. This study gives us the information needed to support the development of policies that can improve this access and, subsequently, the overall health of countless US citizens."

The study also found that the prevalence of hypertension within the Hispanic community increased with increasing age, and was highest among those with Cuban, Puerto Rican, and Dominican backgrounds.

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Community action not enough to reduce problem drinking and related harms

Implementation of community-based interventions alone is unlikely to be effective for reducing most alcohol-related harms and risky alcohol consumption, according to a study by Australian researchers published in PLOS Medicine. Anthony Shakeshaft and colleagues from the National Drug and Alcohol Research Centre at UNSW (University of New South Wales), report that alcohol-related crime, road-traffic crashes, and hospital inpatient admissions did not differ between communities that did and did not implement community-based interventions.

The researchers reached these conclusions by conducting a five year cluster randomized controlled trial (RCT) involving 20 communities in New South Wales. They quantified the effectiveness of 13 community-based interventions using routinely collected data on alcohol-related harms, and a survey of drinking habits and experiences of alcohol-related harm. Interventions included school and work-based education and training, media messaging on harms, screening and brief advice in general practice, pharmacies and hospital emergency departments, and targeting high risk individuals and high risk times.

After implementation of the interventions, the rates of alcohol-related crime, road-traffic crashes, hospital admissions, risky alcohol consumption, and problem drinking were not statistically significantly different between the 10 communities that implemented the interventions and the 10 control communities, although there may have been limited power to detect a difference and uptake for some of the interventions was not consistent across all communities. The researchers did observe that following the interventions, individuals in the intervention communities reported statistically significantly lower average weekly consumption of alcohol than those in the control communities (20% lower, equivalent to 1.9 fewer standard drinks per week per respondent) and alcohol-related verbal abuse. However, these findings must be interpreted cautiously because they are based on low survey response rates.

The authors say: "This RCT provides little evidence that community action significantly reduces risky alcohol consumption and alcohol-related harms, other than potential reductions in self-reported average weekly consumption and experience of alcohol-related verbal abuse."

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Guidance on hospital community benefit programs

A new analysis led by the University of Pittsburgh Graduate School of Public Health offers insights for nonprofit hospitals in implementing community health improvement programs. In a special issue of the Journal of Health Care for the Poor and Underserved that focuses on the Affordable Care Act (ACA), a multidisciplinary team of Pitt researchers explore published research on existing community benefit programs at U.S. hospitals and explain how rigorous implementation of such programs could help hospitals both meet federal requirements and improve the health of the populations they serve.

"Hospitals have long provided uncompensated care to people who could not otherwise afford it, and this in part has justified their nonprofit status. One goal of the ACA is to provide health insurance to more individuals, thereby potentially reducing uncompensated care," said lead author Jessica Burke, Ph.D., M.H.S., associate professor of community and behavioral health sciences at Pitt Public Health. "By working with public health professionals, hospitals can design and implement effective community benefit programs, such as preventative care outreach, that will improve the health of people in their service area and ultimately support continued nonprofit status."

Dr. Burke and her colleagues note that "community health needs assessments," which are required by the ACA and rely on large surveys and input from community stakeholders, including minorities and underserved populations, can provide information to help guide the development of community benefit programs, as well as provide data needed to assess their impact.

By evaluating 106 scientific articles detailing hospital-based community benefit programs, Dr. Burke and her colleagues were able to categorize the programs into those based in the hospital and those administered at a community facility, finding that the programs were split almost evenly.

Hospital-based programs typically included preventative screenings or health education. Outside the hospitals, the programs included hospital after-care and benefits and coverage counseling, but were largely community-based programs, either with or without a community partner organization, such as a local school or community center.

"More than 80 percent of the community-based programs included a community partner, which can facilitate greater reach into a community," said Dr. Burke. "The more you can engage the community in the benefit programs you are trying to provide, the greater the likelihood of a positive outcome."

The analysis reinforces the value hospitals and health systems can derive from partnering with public health professionals to design their community health needs assessments and determine the best community benefit programs to address those needs, said senior author Everette James, J.D., M.B.A., professor of health policy and management in Pitt Public Health and director of Pitt's Health Policy Institute.

"Public health researchers add methodological rigor and experience with a range of evidence-based interventions to hospital community health implementation strategies," said Mr. James, who recently served as the 25th Pennsylvania Secretary of Health. "Our study is intended to strengthen this link between hospital programs and population health, and to provide useful information for hospitals and their public health partners as they comply with new ACA requirements."

UPMC worked with Dr. Burke and her colleagues at Pitt Public Health and Pitt's Health Policy Institute to conduct community health needs assessments for 13 of its hospitals, which the health system then used to guide its community benefit programs and set community health improvement goals.

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