Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Judith Lichtman


Background: Hypertension is a major risk factor for cardiovascular disease (CVD). Blood pressure control is important to reduce cardiac risk for individuals with hypertension. Reduced access to health care may be associated with and blood pressure control.

Methods: To address this issue, the study included participants with hypertension who were enrolled in The Coronary Artery Risk Development in Young Adults(CARDIA) cohort. Using a cross-sectional study design, we examined whether the main predictor---access to care, defined asa cumulative variable of four aspects—whether or not have health insurance; whether or not have regular care resources; whether or not have payment difficulties; whether not seeking for care because of cost for 2years, was associated with blood pressure control, which is the primary outcome. Poor blood pressure control was defined as SBP>= 140 mmHg or DBP >= 90 mmHg for non-diabetic participants; with SBP>= 130 mmHg or DBP >= 80 mmHg for non-diabetic , The potential mediator is Medicate adherence ,which was defined using Morisky Scale.We included demographic factors and risk factors into the analysis and performed Student’s test, chi-square test, Fischer exact test, multivariable logistic regression model and conducted stratified analysis to determine whether decreased access to care was associated with poorer blood pressure control.

Results: Among 1,280 participants with hypertension (44.61% men, mean age 50.49 ± 3.52), 55.23% had 2+ barriers to care, 25.31% had 1 barrier, and 19.45% reported no barriers. Decreased access to care was associated with poorer blood pressure control (p

Conclusion: An increased number of reported barriers to health care was associated with poorer blood pressure control among patients with hypertension. Lack of medication adherence is not a mediator when predicting the controlled blood pressure. The interaction between access to care and use of anti-HTN medicine are statistically significant in this study. According to the stratified analysis, the significant association between barrier to care and blood pressure control still exist even among people using anti-HTN medication. Longitudinal analysis on the CARDIA cohort data and other observational studies and experimental studies should be done to further establish the casual association.


This is an Open Access Thesis.

Open Access

This Article is Open Access