Mapping hypertension control at the intersection of rurality and race and ethnicity, A study of US veterans

Disparities in hypertension control persist for rural-dwelling and for racial/ethnic minoritized Americans. However, the intersection of these characteristics, and their variation by geography, is not well known. We described geographic variation in hypertension control by race, ethnicity, and rurality, using national Veterans Health Administration (VA) data. Our geographic unit of analysis was VA sectors, which are clusters of geographically adjacent counties within VA hospital catchment areas. For each racial and ethnic patient-group, we calculated hypertension control rate for sectors by intra-sector VA facility rurality (all-rural/mixed-urban-rural/all-urban) and created bivariate choropleth maps describing the hypertension-by-sector-rurality categories. We found that racial and ethnic minoritized veterans receiving care in all-rural sectors disproportionately received care from low control sectors, whereas White veterans predominantly received care from facilities in medium hypertension control sectors. Racial and ethnic variation in hypertension control varied by rurality and geography. This finding suggests that race and ethnicity and rurality may intersect on hypertension control with minoritized populations relying more on lower-performing facilities for care. Interventions should account for race, ethnicity, geography, and rurality. Key Policy Highlights Hypertension control varies spatially across the US and US territories. Racial and ethnic minoritized individuals living in rural areas may be dually disadvantaged from both race and rurality. Hypertension interventions to improve racial and ethnic health equity should account for geography and rurality in intervention deployment and tailoring. US healthcare policies and national systems, such as VA, should prioritize improving healthcare in US territories by ensuring adequate resources and addressing structural barriers for territory healthcare facilities.