Effects of Health Insurance Interruption on Loss of Hypertension Control in Women With and Women Without HIV
Year: 2017
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Among low-income women with and without HIV, it is a priority to reduce age-related comorbidities, including hypertension and its sequelae. Because consistent health insurance access has been identified as an important factor in controlling many chronic diseases, we estimated the effects of coverage interruption on loss of hypertension control in a cohort of women in the United States. METHODS: We analyzed prospective, longitudinal data from the Women's Interagency HIV Study. HIV-infected and HIV-uninfected women were included between 2005 and 2014 when they reported health insurance at consecutive biannual visits and had controlled hypertension, and were followed for any insurance break and loss of hypertension control. We estimated hazard ratios (HRs) by Cox proportional hazards regression with inverse-probability-of-treatment-and censoring weights (marginal structural models), and plotted the cumulative incidence of hypertension control loss. RESULTS: Among 890 HIV-infected women, the weighted HR for hypertension control loss comparing health insurance interruption to uninterrupted coverage was 1.37 (95% confidence interval [CI], 0.99-1.91). Inclusion of AIDS Drug Assistance Program (ADAP) participation with health insurance modestly increased the HR (1.47; 95% CI, 1.04-2.07). Analysis of 272 HIV-uninfected women yielded a similar HR (1.39; 95% CI, 0.88-2.21). Additionally, there were indications of uninterrupted coverage having a protective effect on hypertension when compared with the natural course in HIV-infected (HR, 0.82; 95% CI, 0.61-1.11) and HIV-uninfected (HR, 0.78; 95% CI, 0.52-1.19) women. CONCLUSIONS: This study provides evidence that health insurance continuity promotes hypertension control in key populations. Interventions that ensure coverage stability and ADAP access should be a policy priority.
Source: Journal of Women s Health
Institutions: University of North Carolina at Chapel Hill, Albert Einstein College of Medicine, Cook County Health and Hospitals System, Rush University, Emory University, University of Miami, University of California, San Francisco, University of Mississippi Medical Center, Georgetown University Medical Center, University of Southern California, State University of New York, SUNY Downstate Health Sciences University
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: green
Funders: Georgia Clinical and Translational Science Alliance, National Institutes of Health, University of California, San Francisco, National Institute on Alcohol Abuse and Alcoholism, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, National Cancer Institute, National Institute on Deafness and Other Communication Disorders, National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Human Development, National Institute of Dental and Craniofacial Research, Office of Research on Women's Health, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Emory R38 Research Training Program, Emory WIHS CRS - Longitudinal Cohort, The Connie Wofsy Women's HIV Study, Brooklyn Women's Interagency HIV Study (WIHS) V, Mentoring and Empowerment in the Context of HIV Care for At-Risk Populations, Miami Womens Interagency HIV Study WIHS, G4371267688, WIHS Data Management and Analysis Center (WDMAC), Southern California Women's Interagency HIV Study Consortium, Chicago WIHS Consortium V (CWC), Washington Women's Interagency HIV/AIDS Study, Clinical and Translational Science Institute, Atlanta Clinical and Translational Science Institute (ACTSI) Renewal, G6300780520, G6990385686, University of North Carolina Womens Interagency HIV Study UNC WIHS, G767062161, G775892330, G7807729167, Women's Interagency HIV Study (WIHS-V), G8846374971, UAB-MISS WIHS Cohort, G9000080293, G9000122276, Emory Specialized Center of Research Excellence (SCORE) on Sex Differences, UNC MACS/WIHS Combined Cohort Study Clinical Research Site, The University of North Carolina Center for AIDS Research, UCSF-Bay Area Center for AIDS Research
OpenAlex ID: W2727452692