Neighborhood Deprivation and Disparities in Blood Pressure Monitoring in Patients with Intracerebral Hemorrhage
Samuel Namian1, Joel Smith1, Sofia Constantinescu1, Yome Tawaldemedhen1, Cyprien Rivier1, Santiago Clocchiatti-Tuozzo1, Shufan Huo1, Kane Wu1, Rachel Forman1, Victor Torres-Lopez1, N. Abimbola Sunmonu1, Nils Petersen1, Guido Falcone1
1Yale University
Objective:
To test whether neighborhood deprivation was associated with blood pressure (BP) monitoring and whether missing BP around ICH predicted subsequent uncontrolled BP.
Background:
Patients in socioeconomically disadvantaged neighborhoods face barriers to care. Missing BP documentation may signal gaps in risk-factor management, a crucial component of primary and secondary prevention of intracerebral hemorrhage (ICH).
Design/Methods:
We conducted a case-only study within the NIH All of Us Research Program. We included ICH survivors (surviving ≥1-year) with available ZIP3-based social deprivation index (zSDI). Deprivation was categorized as Low, Medium, or High using cohort-based tertiles. We excluded BP measurements collected by All of Us. Outcomes were (1) zero BP assessments and (2) uncontrolled BP (mean systolic BP ≥140 mmHg) during three windows: 0–365 days before ICH; 30–365 days and 1–5 years after ICH. Multivariable logistic regression tested associations.
Results:
2,439 ICH survivors were included (mean age 61.2, 48.7% female). Compared to low deprivation, those living in high deprivation neighborhoods had higher risk of absent BP assessments in the year prior to ICH (OR 2.32, 95% CI 1.88–2.87; p<0.001), 30–365 days post-ICH (OR 2.59, 2.09–3.20; p<0.001) and 1–5 years post-ICH (low vs high, OR 2.86, 95% CI 2.31–3.54; p<0.001). Absence of BP assessments in the year before ICH predicted uncontrolled hypertension 30-365 days (OR 1.69, 95% CI 1.25–2.28; p<0.001; N=1,483) and 1–5 years (OR 1.88, 1.42–2.50; p<0.001; N=1,426) after ICH. Absence of BP assessments 30–365 days post-ICH also predicted uncontrolled BP 1–5 years post-ICH (OR 1.88, 95% CI 1.40–2.52; p<0.001; N=1,426).
Conclusions:
Neighborhood deprivation is associated with persistent gaps in BP documentation surrounding ICH, and missing BP assessments before or soon after ICH predicts subsequent hypertension. These findings highlight the need for systemic solutions that ensure equitable BP assessment for socioeconomically disadvantaged populations.
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