African American service members had higher incidence rates of hypertension compared to service members of other races and ethnicities despite equitable access to health care within the military health system, according to a new analysis by the Armed Forces Health Surveillance Center (AFHSC).
Black, non-Hispanic service members had a rate of 24.4 new diagnoses of hypertension per 1,000 person-years (p-yrs), nearly 50 percent higher than the rates among members of all the other racial and ethnic groups studied, according to the analysis published in the Medical Surveillance Monthly Report, a peer-reviewed journal on illnesses and injuries affecting service members. The analysis provides estimates of counts, rates and trends measured against the American Heart Association metric for cardiovascular health for hypertension, hyperlipidemia, obesity, abnormal blood glucose level, and diabetes.
"We would expect to see less disparity in hypertension rates across racial groups due to equal access to health care and equitable social and economic status; however, black, non-Hispanic service members remained disproportionately affected," said Army Colonel William Corr, the deputy director of AFHSC's division of Epidemiology and Analysis. "Continued research examining this disparity is warranted and may favorably impact all service members' long term health."
The surveillance period for the analysis, "Incidence and Prevalence of Select Cardiovascular Risk Factors and Conditions, Active Component, U.S. Armed Forces, 2003-2012," was 1 January 2003 to 31 December 2012. The surveillance population included all members of the U.S. Army, Navy, Air Force, Marine Corps, and Coast Guard who served in the active component at any time during the surveillance period.
During the surveillance period, there were 230,564 incident diagnoses of essential hypertension in active component service members. The overall incidence rate for the period was 16.1 per 1,000 p-yrs.Incidence rates of hypertension remained relatively stable during the period; rates were highest in 2005 (17.4 per 1,000 p-yrs.) and have been lower during the last four years of the surveillance period as compared to the first four years of the period.
Incidence rates among African American service members were higher than rates in other racial and ethnic groups in all age groups. While incidence in black, non-Hispanics decreased during the period in individuals 35 or over, incidence rates in those under 35 were higher in 2012 than at the beginning of the period.
The results of the analysis mirror a report published in 2012 that examined several of the same conditions in U.S. Air Force members. That study also reported that African Americans had a higher prevalence of hypertension in every age category as compared to white, non-Hispanic airmen. The authors noted that many of the hypothesized factors for this disparity (e.g. social and economic factors and access to health care) are potentially less pronounced in a "prescreened USAF population with equitable heath care and living conditions."
Because service members undergo frequent and routine periodic health assessments, there are multiple opportunities to assess, diagnose and treat CVD risk factors during the course of their service. In fact, the increasing incidence rates of several conditions among younger service members (e.g., hypertension) may reflect increased awareness and earlier diagnosis.
While the more severe sequelae of these risk factors for CVD conditions may not become manifest while service members are actively serving, increased surveillance and control of these risk factors have the potential to favorably impact service members' long term health, thereby improving their quality of life and potentially reducing future medical costs for the care of chronic health conditions.
Among the other findings in the AFHSC report:
•A total of 300,340 service members received incident diagnoses of hyperlipidemia during the 10-year surveillance period; about 90 percent of these diagnoses (n=271,164) occurred among male service members. As with hypertension, the strongest demographic correlate of increasing incidence of hyperlipidemia was increasing age. Incidence rates of hyperlipidemia were similar among all race-ethnicity groups with the exception of American Indian/Alaskan Native service members who had much lower incidence rates of hyperlipidemia between 2003 and 2012 than service members of other races and ethnicities.
•Overall incidence rates of obesity were highest in the final year of the surveillance period (2012: 21.5 cases per 1,000 p-yrs), although incidence rates fluctuated over the ten year period and no steady increasing trend was seen.
•Relative to hypertension and hyperlipidemia, fewer service members received incident diagnoses of abnormal glucose metabolism during the surveillance period (n=47,009). However, annual incidence rates of diagnoses of abnormal glucose metabolism increased dramatically over the course of the ten year period (2003: 0.17 cases per 1,000 p-yrs; 2012: 5.3 per 1,000 p-yrs).
•Incident diagnoses of diabetes impacted the fewest service members of the five risk factors examined; 13,901 service members received an incident diagnosis of diabetes during the ten year period and incidence rates of diabetes remained relatively stable during the ten year period.
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