County Prevalence and Control of High Blood Pressure from Health Kiosks, 2017-2024

Background As the leading modifiable risk factor for death in the United States, hypertension requires timely and locally detailed surveillance. Current estimates of the high blood pressure (BP) care continuum are lagged national averages from sample surveys with low participation and unknown subnational variation. This study explores the use of self-service health kiosks in retail stores as an alternative source for subnational estimates of prevalence, awareness, and control. Methods We analyzed data from adult kiosk users (n = 1,270,485) across 1,892 counties in 49 States (except Massachusetts) and District of Columbia in a serial cross-sectional analysis from November 2017 to September 2024. High BP was defined as self-reported diagnosed or elevated BP (systolic ≥140 mmHg or diastolic ≥90 mmHg). Among those diagnosed, control was defined as BP <140/90 mmHg. Small area estimates for counties were calculated using multilevel regression and poststratification based on individual and areal socio-demographic covariates. We compared the prevalence of diagnosed hypertension with the Behavioral Risk Factor Surveillance System 2021. Results The analytic sample had a mean age of 42.0 years (SD=15.6). Prevalence of high BP was 51.9% in 2017-2018 and 50.4% in 2023-2024. In 2023-2024, awareness and control were 73.7% and 61.8% and county-level prevalence ranged from 39.5% to 63.1%. Similar hotspots in the Southeast were identified in both kiosk and BRFSS (Spearman's ρ = 0.52). Conclusions Health kiosk data reveal substantial spatial and socio-demographic variation in high BP. Near real-time sub-national surveillance of health kiosk users can provide insights to guide interventions and track progress.