Hypertension Care Quality and Incidence of Complications Among Hypertensive Patients With Disabilities in Korea: An Analysis of a Cohort Study Using National Health Insurance Data

Abstract

Background: Hypertension is more prevalent among individuals with disabilities than in the general population. This study analyzed long-term trends in disparities in hypertension care quality and the incidence of hypertensive complications among individuals with and without disabilities. Methods: This retrospective cohort study followed 52,743 hypertensive patients aged 20 or older with disabilities newly diagnosed in 2010, along with 47,564 age-and sex-matched patients without disabilities, from 2011 to 2019. Hypertension care quality was assessed using indicators of medication adherence and the completion of three complication-monitoring tests at recommended frequency: blood test, urine test, and electrocardiogram (ECG). Hypertensive complications included major cardiovascular and cerebrovascular events, kidney diseases, and all-cause mortality. Logistic regression was repeated annually to assess hypertension care quality, and Cox-proportional model was used to estimate the risk of hypertension-related complications. Results: Hypertensive patients with disabilities consistently demonstrated lower medication adherence throughout the study period (adjusted odds ratio [aOR], 0.90-0.96, depending on the year), but a higher likelihood of undergoing screenings at recommended frequency (e.g., aOR for blood test, 1.31-1.39, for urine test, 1.24-1.33, and for ECG, 1.30-1.37). The risk of complications remained significantly higher among hypertensive patients with disabilities, even after adjusting for care quality indicators (e.g., adjusted hazard ratio for cardiovascular events: 1.36, 95% confidence interval: 1.31-1.41). Subgroup analyses revealed that the excess risks for complications varied across different sociodemographic groups. Conclusion: These findings underscore the need for comprehensive strategies to enhance medication adherence among hypertensive patients with disabilities. Additionally, other factors beyond medication adherence and monitoring test completion that contribute to the increased risk of complications require further exploration.