Hypertension in Young Adults: Social Determinants of Prevalence, Awareness, Treatment, and Control

BACKGROUND: Hypertension prevalence remains high among US young adults, and the role of social needs in their hypertension management remains poorly understood. METHODS: Data from 2017 to 2020 National Health and Nutrition Examination Surveys (N = 8,024, representing 244 million adults) were used to study hypertension, defined per 2017 ACC/AHA guidelines or self-report of blood pressure-lowering medications. Prevalences of hypertension, awareness of condition, treatment if aware, and control if treated were estimated among young (18-39 years), middle-aged (40-64 years), and older adults (≥65 years). Weighted log binomial regression estimated associations between social needs (0, 1, or ≥2) and hypertension outcomes, adjusted for age, sex, and race/ethnicity. Social needs included less than high school education, family income <100% of the federal poverty level, no health insurance, food insecurity based on the U.S. Food Security Survey, and current unemployment. RESULTS: Among 2,680 young adults (weighted N = 92 million; 51% female, 58% NHW), hypertension prevalence was 22.6% (95% CI, 19.5-25.7). Among those with hypertension, 19.3% of young, 20.2% of middle-aged, and 10.0% of older adults had ≥2 social needs. Among treated adults, those with ≥2 vs no social needs were less likely to have controlled hypertension (adjusted risk ratio [aRR]: 0.74; 95% CI, 0.59-0.92). This aRR was 0.75 (95% CI, 0.43-1.32) in young adults, 0.74 (95% CI, 0.57-0.96) in middle-aged adults, and 0.73 (95% CI, 0.51-1.04) in older adults (p for interaction = 0.12). CONCLUSIONS: Unmet social needs, more prevalent among young adults, were associated with lower rates of hypertension control, highlighting directions for interventions.