# Evaluating Control of Hypertension - Effect of Social Determinants (ECHOES)

> **NIH NIH R01** · OREGON HEALTH & SCIENCE UNIVERSITY · 2021 · $619,232

## Abstract

Project Summary
Hypertension (HTN) is the most common chronic condition among adults in the United States (US). Uninsured
adults are more likely to have undiagnosed HTN, less likely to receive regular screening, and less likely to
have their HTN under control than insured adults. Prior studies of individual states' Medicaid expansion
showed that gaining insurance increased healthcare service utilization, receipt of recommended preventive
care, and improved health outcomes; but these studies were limited by having no comparison group. More
recently, multiple states were impacted by federal policy changes (e.g., Affordable Care Act [ACA]), creating
`natural experiments' to assess whether and how gaining (or losing) health insurance improves HTN prevention
and care. Further, there is variability in how states choose to expand or contract coverage, which creates
opportunities to identify `intervention' and `control' states (e.g., some states expanded Medicaid eligibility, while
others did not). We are well-poised to study the ACA Medicaid expansion natural policy experiment and other
policy changes that may unfold in the next few years. In addition, access to care through health insurance may
be insufficient to reduce barriers to HTN care. Thus, other social determinants of health ([SDOH]; e.g.,
individual- and community-level factors) may differentially affect the relationship between gaining insurance
and receiving HTN care. We will use electronic health record (EHR) data from the ADVANCE clinical data
research network, linked to community-level SDOH, which has data from 599 community health centers
(CHCs), including 376 CHCs in 14 Medicaid expansion states (n=1,139,779 patients) and 224 CHCs in 8 non-
expansion states (n=658,306 patients). From this dataset, we will collect detailed information on changes in
HTN incidence, screening, treatment, and management comparing states that expanded Medicaid, and those
that did not. The specific aims are as follows: Aim 1. Compare HTN incidence, prevalence of undiagnosed
HTN, and rates of HTN screening, in Medicaid expansion versus non-expansion states before and after the
ACA. Aim 2. Compare HTN treatment and management in Medicaid expansion versus non-expansion states,
before and after the ACA. Aim 3. Assess the extent to which rates of HTN incidence, screening, and treatment
effectiveness among patients who gained insurance versus those continuously insured or uninsured, pre-post
ACA, are moderated by individual-level SDOH (e.g., race, ethnicity). Aim 4. Explore the interaction between
community-level SDOH (e.g., neighborhood racial segregation and deprivation) and HTN screening, treatment,
and management among patients who gained insurance relative to those who were already insured or
uninsured, in expansion states. We will build directly on our preliminary work and take advantage of the diverse
strengths of our multidisciplinary team. The ADVANCE dataset uniquely positions us to assess current and
futu...

## Key facts

- **NIH application ID:** 10161813
- **Project number:** 5R01HL136575-04
- **Recipient organization:** OREGON HEALTH & SCIENCE UNIVERSITY
- **Principal Investigator:** Jennifer E DeVoe
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $619,232
- **Award type:** 5
- **Project period:** 2018-04-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10161813

## Citation

> US National Institutes of Health, RePORTER application 10161813, Evaluating Control of Hypertension - Effect of Social Determinants (ECHOES) (5R01HL136575-04). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10161813. Licensed CC0.

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