Background: There is evidence that significantly disruptive health events, such as hospitalizations, may increase patients’ receptiveness to interventions that lead to healthier lifestyle choices and medication adherence. For example, research has shown that hospitalizations are particularly effective settings for delivering some interventions aimed at preventing chronic disease morbidity, such as intervening on tobacco use. Additional opportunities may exist to harness hospitalizations to address a broader array of chronic diseases, but the scope of those opportunities is not well-described. This study aimed to characterize the prevalence of poorly controlled hypertension, hyperlipidemia, and diabetes among recently hospitalized community-dwelling adults.
Methods: We conducted an analysis using the National Health and Nutrition Examination Survey (NHANES), which is a survey that samples non-institutionalized civilians to provide nationally representative estimates. We included adults enrolled in NHANES between January 2017 to March 2020 who reported an overnight hospitalization in the preceding year. Respondents were considered to have a potential opportunity for a chronic disease intervention if they had poorly controlled hypertension, hyperlipidemia, or diabetes at the time of being surveyed. Poorly controlled chronic diseases were defined as: 1) hypertension: self-reported diagnosis of hypertension and a blood pressure reading >140/90 mmHg during the exam portion of the survey, and on 1 or more anti-hypertensive medications; 2) hyperlipidemia: aged 40-70, ASCVD risk score >7.5%, and not on lipid lowering therapy; and 3) diabetes: hemoglobin a1c>7% and age < 65 years. Frequencies and counts were used to describe the combined population of patients with a potential opportunity for chronic disease intervention during hospitalization. Chi-square and t-tests were used to assess for respondent characteristics associated with a potential opportunity for chronic disease intervention. Percentages reported in the results are weighted while counts are unweighted unless otherwise specified.
Results: Of all surveyed adults, 935 had a hospitalization in the previous year. Among those with a hospitalization, 23.6% (95%CI: 20.5%-26.8%, n=282), corresponding to a weighted count of 5,563,810 individuals (95%CI: 4,394,885-6,732,735), had poorly controlled hypertension, hyperlipidemia, or diabetes at the time of their survey and would be potentially eligible for intervention. Those who were potentially eligible for intervention were on average older (63.6 vs 51.6 years, p< 0.001), more likely to be male (29.1% versus 20.1%, p=0.003), and more likely to not have a high school degree (18.4% versus 11.8%, P< 0.001), but there were no differences by race/ethnicity or family income-to-poverty ratio (both p>0.05).
Conclusions: In a nationally representative cohort of recently hospitalized community-dwelling adults, we found a high prevalence of poorly controlled chronic diseases in the year following discharge. This supports a potential opportunity for hospital-based chronic disease management efforts, which should be further studied using data sources that can clarify temporal associations between disease control and hospitalization. Given this prevalence and prior successful efforts utilizing hospitalizations as a “touch-point” for care management strategies, we should consider future efforts to address chronic disease management in the hospital setting.