A twenty-year illness trajectory of hypertensives: Hospitalization and mortality among Black and White adults in the United States

Ya-ping Su, Purdue University

Abstract

Hypertension is a serious public health problem in the United States. Research in the past has identified possible risk factors for hypertension, but little is known about the lifelong illness trajectory of hypertensives, except from clinical data. The study used data from the first National Health and Nutrition Examination Survey (1971–75) and the Epidemiologic Follow-up Study (1982–1992) to examine the illness trajectory of hypertensive patients. Two major outcomes examined were hospitalization and mortality. Sub-sample analysis of hospitalization for the survivors indicated that those who had uncontrolled hypertension and Black adults unaware of hypertension were more likely to be hospitalized frequently during the second 10 years of the study. Among the decedents, hypertension did not affect hospital stays. Respondents with hypertension were more likely to be hospitalized for circulatory system disease. Black adults were less likely to be hospitalized but were more likely to be hospitalized for neoplasm and digestive system diseases. Black adults who had controlled hypertension or who were hypertensive for more than 10 years were found to spend fewer nights hospitalized for the second 10 years of the study. A significant effect of hypertension status was found mostly in the second 10 years of the study which suggests that hypertension might not be an immediate health risk. In the long run, however, it could endanger an individual's health and necessitate hospitalization. Respondents who had controlled hypertension did not have a greater risk of hospitalization and mortality over the 20 years than did the normotensives. Individuals with uncontrolled hypertension and those unaware of their hypertension were at higher risk of mortality from ischemic heart diseases (IHD) and heart disease other than IHD. However, older adults with uncontrolled hypertension were observed to have a lower risk of re-hospitalization as well as a lower risk of all-cause mortality. A Black-White crossover was observed for all-cause mortality and heart disease other than IHD mortality at old age. Health behaviors that most often predicted hospitalization and mortality were: smoking, moderate alcohol intake, obesity, overweight, and underweight. Future research is suggested to examine the health trajectory and quality of life for people with hypertension.

Degree

Ph.D.

Advisors

Ferraro, Purdue University.

Subject Area

Public health|Ethnic studies

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