Answer 2 for NURS 8310 Week 2 Discussion: Descriptive Epidemiology Evaluation of Selected Health Problem
For the selected health problem, hypertension in the U.S. population, the three categories of person, place, and time can be used to describe the pattern of hypertension in this population. The person category involves who might be affected by hypertension. The category of place includes focus on where hypertension may be occurring in the U.S. Finally, time entails when hypertension may be occurring. These three characteristics aid in the descriptive epidemiology for occurrence of hypertension as a disease focus (Friis & Sellers, 2021).
Person
Those affected by hypertension in the U.S. tend to be greater than 65 years of age, are male, and black. Due to long latency periods between exposure and allowance of disease to develop relatively unchecked, the older population tends by more affected by hypertension than other age groups (Dreisbach, 2020; Mills et al., 2020). Males with hypertension have a higher morbidity rate with additive effects compared to women. However, determining mortality rates for hypertension in the older age group is often difficult. The social group membership includes those of a black, non-Hispanic race and American Indian/Alaska Native adults which promotes the inequities seen in accessing of healthcare. Although Black adults are more likely to develop hypertension at a younger age compared to other races (America’s Health Rankings, 2021; Bress et al., 2021; Dreisbach, 2020; Mills et al., 2020). Additional person-centered risks for hypertension may include those who are obese, smoke, are sedentary, and consume an unhealthy diet, especially one high in sodium and low in potassium, and use alcohol excessively (America’s Health Rankings, 2021). These areas may serve as starting points for change with those identified as having high blood pressure.
Place
Inequities and access to healthcare often affect those who are at risk for, undiagnosed, or experiencing uncontrolled hypertension. These may include individuals living in low-income and undeveloped areas. The living environment may also put individuals at an increased risk for hypertension development, as with areas plagued by pollution or high noise levels (Dreisbach, 2020; Mills et al., 2020). America’s Health Rankings (2021) stated 32.5% of persons in the U.S. have high blood pressure with the least-healthy state being West Virginia at 43.8% of its population being hypertensive. This could be related to stresses caused by social and economic factors experienced by persons in this state, especially Black adults.
Time
Hypertension is a chronic disease that makes understanding mortality difficult related to additional chronic diagnoses concurrently afflicting those commonly stricken with it, the geriatric population. As hypertension is the leading cause of cardiovascular disease and health disparities in the U. S. related to treatment and control, it is of importance to diagnose and treat early for comorbidity prevention (Bress et al., 2021; Imam et al., 2020).
An example of the length of time that can expire between initial high blood pressure readings and a formal diagnosis for treatment in elderly persons can be upwards of 10-years. Imam et al. (2020) found elderly patients to have elevated blood pressure, ≥140/90 mmHg during screening and were referred to their provider for further work up. However, 70% of those individuals were not diagnosed for up to 10-years with the mean time being 5-years. But is it not known if the delay was related to provider or patient lack of follow-up. Knowing the level of chronicity for this disease, this time frame needs to be drastically changed (Imam et al., 2020).
High blood pressure is often referred to as the silent killer related to it not having signs and symptoms early on. Conducting screening for hypertension with each elderly patient encounter is needed to identify those with hypertension, then treatment needs to ensure promptly with a combination of altering modifiable risk factors and medication institution. Control of blood pressure can be accomplished through a combination of diet, exercise, and medication interventions. Timing of costs regarding hypertension include a $55.9 billion tag in 2015 but estimates for direct costs are projected to increase towards $220.9 billion by 2035 (America’s Health Rankings, 2021).
Appraisal of Data Sources
The Bress et al. (2021) study was funded conducted by a reputable source, the American Heart Association. They provide data and trends to back up their statements regarding health disparities in many areas. They provided a variety of areas that providers can address to promote health in those at risk for or who currently have hypertension. They also were honest in presenting not only the patient’s contributions to lack of control, but also the provider’s contributions to the inequities for blood pressure control. Their article associated the complications of the pandemic with difficulties controlling hypertension which represented currency in worldly events. However, they did not present a section on limitations of their study as we usually see.
Dreisbach (2020) provided a good outline for areas of interest related to hypertension, such as estimates in the world versus the U.S., distribution and prevalence related to age, sex, and race/ethnicity, as well as associated comorbidities. The author also presented information on how genetics may play a role in the development of hypertension. This article brought in reliable data sources, such as the National Health Examination Surveys (NHANES) and National Center for Health Statistic Surveys (NCHS) to bring awareness to readers for hypertension. An additional strength was the use of reliable trial data to support findings (i.e., Systolic Blood Pressure Intervention Trial or SPRINT and the ACCORD trial). The Dreisbach (2020) article was more of a presentation of hypertension data and not a true study, but evidence from other studies and trials were brought forward to allow the reader to understand the importance of hypertension and the need for control.
The Imam et al. (2020) article was more of an actual presentation of a quantitative study. It was outlined in the traditional format for presentation of study findings. They included a section discussing the strengths and weaknesses of the study, as is expected with dissemination of study findings. Their suggestions were easy to follow and could easily be implemented. Some of their findings did not match the situational findings of other studies used for data comparison. For example, they used 30-minutes of resting supine prior to obtaining a blood pressure which is longer than that often used in the clinical settings. This time frame gap could have contributed to differences in readings. Another area of concern is that they did not obtain years to diagnosis on all participants, as this data was not available in all patient charts. Also, they only focused on one area in the country of focus. The 30% of those undiagnosed within the 10-year timeframe could have been diagnosed elsewhere. An additional study strength included the large sample size.
Mills et al. (2020) was considered a review of hypertension. However, the article provided an overview of the global and national association of this disease. They included associated chronic disease risks and mortality associated with hypertension and health disparities and inequities associated with it, such as low income. The authors provided listings of modifiable risk factor associated with the development of high blood pressure which lends to a potential treatment plan to prevent or control hypertension development. They also presented health promotion measures for disease recognition at the community level with specific screenings. They showed the seriousness of this disease with a final focus on the cost of hypertension, not only in one’s health but also with finances.
Methods for Collecting Raw Data
According to Fiis and Sellers (2021) use of patient electronic medical records, social media, and evaluation of smart device data can serve as methods for collecting raw data on hypertensive patients, either diagnosed or not. Screenings during office visits or at health fairs and via surveys can be other methods of gathering data and identifying risks and/or high blood pressure numbers for diagnostic purposes. These methods can aid in the completeness of case identification or case definition and diagnostic criteria used through the identification of a patient specific case of interest for simulation, training, or publication. Use of data for the development of evidence-based studies to promote guidelines and criteria for diagnosing and treating hypertension can also be another focus. Cases derived from obtained data can lead to practitioners being able to better diagnose earlier and intervene with treatment timely (Onggo & Hill, 2014).
References
America’s Health Rankings. (2021). Public health impact: High blood pressure. United Health Foundation. https://www.americashealthrankings.org/explore/annual/measure/Hypertension/state/ALL
Bress, A. P., Cohen, J. B., Anstey, D. E., Conroy, M. B., Ferdinand, K. C., Fontil, V. Margolis, K. L., Muntner, P., Millar, M. M., Okuyemi, K. S., Rakotz, M. K., Reynolds, K., Safford, M. M., Shimbo, D., Stuligross, J., Green, B. B., & Mohanty, A. F. (2021). Inequities in hypertension control in the United States exposed and exacerbated by COVID-19 and the role of home blood pressure and virtual health care during and after the COVID-19 pandemic. Journal of the American Heart Association, 10(11), e020997. https://doi.org/10.1161/JAHA.121.020997
Dreisbach A. W. (2020). Epidemiology of hypertension. Medscape. https://emedicine.medscape.com/article/1928048-overview
Friis, R. H., & Sellers, T. A. (2021). Epidemiology for public health practice (6th ed.). Jones & Bartlett Learning.
