Social Determinants of Health and Uncontrolled Hypertension in Emergency Department Patients: A Multicenter Analysis

Objective: The role of social determinants of health (SDOH) among adult emergency department (ED) patients with hypertension remains largely unexplored. This study aims to address this critical knowledge gap. Methods: Electronic Health Record data from patients visiting six urban EDs between September 1, 2019, and October 21, 2022 with hypertension [Stage 1 hypertension (two blood pressure readings ≥ 130/80 mmHg)] or Stage 2 hypertension (≥140/90 mmHg)] were obtained along with their demographic and social characteristics such as employment, age, sex, insurance status and comorbidities. Bivariate analysis and multivariate regression modeled the odds of hypertension with demographic and social data, reported as odds ratios (OR) with 95% confidence intervals (CI). Results: Among 822,843 encounters, 22.8% (n = 187,664) involved patients with Stage 1 hypertension. These patients were middle-aged (mean age 60 years) and were more likely to have a prior diagnosis of hypertension (OR 3.02, 95% CI 2.96–3.09), be male (OR 1.14, 95% CI 1.12–1.14), African American (OR 1.40, 95% CI 1.37–1.42), and current smokers (OR 1.05, 95% CI 1.03–1.06), and less likely to be publicly insured (OR 0.91, 95% CI 0.89–0.92). Stage 2 hypertension occurred in 13.0% of encounters (n = 109,231). These patients had a similar mean age (63 years) and showed comparable associations, including higher odds of being African American (OR 1.61, 95% CI 1.58–1.64), unemployed (OR 0.50, 95% CI 0.47–0.52), having a prior hypertension diagnosis (OR 3.37, 95% CI 3.30–3.45), and smoking (OR 1.09, 95% CI 1.06–1.11). They were also less likely to be publicly insured (OR 0.91, 95% CI 0.89–0.93) or to present during the COVID period (OR 0.92, 95% CI 0.89–0.95). Conclusions: In this large, multicenter ED-based cohort, elevated blood pressure was consistently associated with key social and demographic factors, including race/ethnicity, insurance status, employment, and smoking. These findings underscore the importance of considering social context when evaluating hypertension in emergency department settings.