Neighborhood Deprivation Significantly Associated with Hypertension in Youth

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Children living in areas with greater neighborhood deprivation in the US have a higher likelihood of being diagnosed with primary hypertension, according to an analysis of more than 65,000 children.

Residence within a high-deprivation neighborhood in the United States was associated with a 60% greater likelihood of a primary hypertension diagnosis among children, according to a new cross-sectional study.1

The analysis implied the association between area deprivation index (ADI) and primary hypertension diagnosis was rivaled only by a diagnosis of obesity, which was associated with 5 times greater odds of a primary hypertension diagnosis. Other associated risk factors included older age, male sex, and longer duration of full Medicaid coverage.

“The relationship between the level of neighborhood deprivation and primary hypertension in youth has not been well evaluated,” said the study’s lead author Carissa Baker-Smith, MD, MPH, director of Pediatric Preventive Cardiology, Nemours Children’s Health, Delaware Valley.2 “Perhaps as a result, strategies for screening and diagnosis of hypertension do not routinely consider a child’s community as a potential risk factor.”

Prior literature has highlighted numerous risk factors associated with primary hypertension development, but no studies in the US have evaluated the association between ADI and primary hypertension diagnosis among insured children and adolescents. Physician recognition of hypertension has additionally been reported as poor, with factors influencing diagnosis in youth including older age, male sex, obesity, and higher blood pressure.

Investigators in the current study hypothesized that a higher ADI, even among Medicaid-insured children, would be associated with a greater likelihood of primary hypertension diagnosis. For the investigation, Baker-Smith and colleagues performed a cross-sectional analysis of data from Delaware Medicaid recipients aged 8 to 18 years between 2014 and 2019. The age range was chosen due to reports of a higher prevalence of hypertension among children aged 8 to 9 years and to capture key developmental points for the diagnosis of hypertension.

After exclusions, the final analysis consisted of 65,452 children. Investigators identified 1145 (1.7%) children with a diagnosis of primary hypertension (mean age, 13.3 years; 464 [41%] female), with the greatest prevalence among youths aged 13 to 18 years.

Among those with a primary hypertension diagnosis, 614 (54%) had an ADI greater than or equal to 50. Additionally, patients with a primary hypertension diagnosis were more likely to have an obesity diagnosis (705 [62%] vs 13,029 [20%]). The mean duration of full Medicaid benefit coverage was 61 months for those with a diagnosis of primary hypertension compared to 46 months for those without a diagnosis.

Multivariable analysis revealed the patient-level factors associated with a greater likelihood of a primary hypertension diagnosis included residence within communities with ADI greater than or equal to 50 (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.04 - 2.51). Other factors associated with greater odds of a primary hypertension diagnosis were older age (OR, 1.16; 95% CI, 1.14 - 1.18), an obesity diagnosis (OR, 5.16; 95% CI, 4.54 - 5.85), and a longer duration of full Medicaid benefit coverage (OR, 1.03; 95% CI, 1.03 - 1.04).

On the other hand, investigators found female sex was associated with a lower likelihood of a primary hypertension diagnosis (OR, 0.68; 95% CI, 0.61 - 0.77; P <.001). The study did not observe an association between race or ethnicity and a primary hypertension diagnosis.

Baker-Smith and colleagues stressed the importance of neighborhood deprivation when assessing the presence and prevalence of primary hypertension in youth, particularly for screening algorithms and national guidelines.

“Knowledge of risk factors for hypertension in youth is essential to improve cardiovascular outcomes in later life,” Baker-Smith said.2 “Our study highlights the importance of considering neighborhood-related factors when diagnosing hypertension.”


  1. Baker-Smith CM, Yang W, McDuffie MJ, et al. Association of Area Deprivation With Primary Hypertension Diagnosis Among Youth Medicaid Recipients in Delaware. JAMA Netw Open. 2023;6(3):e233012. doi:10.1001/jamanetworkopen.2023.3012
  2. Areas of greater socioeconomic disadvantage linked to 60% greater likelihood of a primary hypertension in Youth. EurekAlert! Published March 15, 2023. Accessed March 15, 2023.