Urban-rural Differences in Visits to Office-based Physicians by Adults With Hypertension: United States, 2014-2016.

Abstract

made by adults aged 18 and over with documented hypertension by age, sex, and race and ethnicity during 2014-2016. Methods-Data are from the 2014-2016 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of visits to nonfederal, officebased physicians. The study population includes all office-based physician visits made by nonpregnant adults aged 18 and over with complete data on patient residence. Patient residence is based on the county of patient residence. The primary outcome is the percentage of visits with diagnosed hypertension, as defined by documentation of hypertension in their medical record. Variation in visits with documented hypertension was assessed by patient residence, sex, age, and race and ethnicity. Results-During 2014-2016, the percentage of visits by adults aged 18 and over with diagnosed hypertension who lived in large metro suburban areas (34.2%) was lower than visits by adults who lived in small-medium metro areas (37.9%) and rural areas (40.1%). The percentage of visits by men with hypertension (41.0%) was higher than women (33.5%) overall and in large metro suburban areas (38.7% for men and 31.0% for women), small-medium metro areas (43.5% for men and 33.8% for women), and rural areas (44.9% for men and 36.5% for women). The percentage of visits by adults with hypertension increased with age, from 10.3% for adults aged 18-44 to 58.6% for adults aged 75 and over. This same pattern was observed in all patient residence areas. The percentage of visits by non-Hispanic black adults with hypertension (47.3%) was higher than for non-Hispanic white adults (35.7%) and for Hispanic adults (34.6%). This same pattern was observed in large metro urban and large metro suburban areas.