Abstract 87: Area Deprivation And Race Synergistically Contribute To Undiagnosed Hypertension Leading To Acute Ischemic Stroke

Background: Area deprivation is one of the leading social determinants of health and is associated with lower access to clinical care. We hypothesize that undiagnosed hypertension is more prevalent in highly deprived areas as well as in people from black race and that undiagnosed hypertension is associated with a higher risk of incident stroke. Methods: We conducted an observational study analyzing participants from the All of Us study (AoU). We identified people who meet the criteria for hypertension based on blood pressure measurements at the time of enrollment but were not known to have the condition according to EHR or survey data. We evaluated area deprivation using the Deprivation Index (DI), an aggregate variable derived from six metrics of the American Community Survey. We used multivariable logistic regression to test for interaction between tertiles of DI and race in a model predicting undiagnosed hypertension adjusting for age, sex, income, and education. Results: Out of 372,397 participants enrolled in AoU, 269,063 had data for area deprivation and blood pressure, including 6,690 (2.5%) who sustained a stroke. Compared to low area deprivation, intermediate and high deprivation were associated with 3.4% (OR 1.034, 95%CI 1.00-1.07) and 17.4% (OR 1.174, 95%CI 1.14-1.21) higher risk of undiagnosed hypertension (test-for-trend p<0.0001). Compared to White participants, Black participants had a 67.4% (OR 1.674, 95%CI 1.62-1.73, p<0.0001) higher risk of undiagnosed hypertension. There was significant synergy between DI and race (interaction p<0.0001): compared to White participants living in areas of low deprivation, Black participants living in areas of high deprivation had 106% (OR 2.06, 95%CI 1.96-2.16, p<0.0001) higher risk of undiagnosed hypertension. In the whole cohort, undiagnosed hypertension was associated with a 34% (OR 1.34, 95%CI 1.12-1.62, p=0.002) higher risk of incident stroke when adjusting for prevalent hypertension and the remaining socioeconomic factors. Conclusion: High area deprivation and Black race are associated with a higher risk of undiagnosed hypertension. Undiagnosed hypertension is associated with a higher risk of ischemic stroke after accounting for prevalent hypertension diagnosis.