Changes in hypertension control after a temporary reduction in access to health care: A two-year follow-up analysis of Superstorm Sandy
Discussant: Aditi P. Sen
Objective: To evaluate long-term changes in chronic disease control attributable to a temporary six-month reduction in access to health care.
Design: Difference-in-differences analysis to compare within-patient changes in chronic disease control over time between those exposed to reduced health care access vs. a non-exposed cohort.
Setting: Veterans Health Administration(VA) Manhattan Medical Center (exposed) and the VA Bronx, Brooklyn, or New Haven Medical Centers (controls).
Participants: 81,544 adult veterans.
Intervention: The six-month closure of VAManhattan Medical Center following Superstorm Sandy.
Measurements: Uncontrolled blood pressure (mean blood pressure per patient per quarter >140/90 mmHg), diabetes (mean glycated hemoglobin per patient per quarter >8%), and cholesterol (mean low density lipoprotein per patient per quarter >140 mg/dl).
Results: There were 19,207 and 62,337 individuals in the exposed and control groups, respectively. During the closure, there was a 24.8% absolute reduction (51.9% relative reduction) in the percent of veterans with any VA primary care visit per quarter (95% CI: -26.5 to -23.0%; p<0.001) from a pre-storm baseline of 47.8%. By one year after the hospital reopened, there was no differential change in the percentage of veterans with a primary care visit between groups (p=0.93), but exposed veterans were 25.9% more likely to have uncontrolled blood pressure vs. controls (absolute increase 5.0%, 95% confidence interval [CI]: 3.5-6.0). There were no observed differential changes in uncontrolled diabetes or cholesterol.
Limitations: Observational study design focused on a population of veterans.
Conclusions and Relevance: A transient period of reduced access to care was associated with a persistent negative impact on hypertension control.
