ArticlePreventive medicine reports2025
Disentangling unobserved heterogeneity: Novel application of a statistical method to evaluate a multilevel healthcare intervention for hispanic individuals living on the United States-Mexico border with comorbid diabetes and hypertension.
Article in Preventive medicine reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Individuals with diabetes and hypertension represent a high-risk population with poor prognosis and high healthcare costs. Clinicians recognize the complexities of treating patients with multiple chronic conditions; however, the research literature shows little attention to characterizing change patterns in hypertension outcomes for participants of health interventions. The aim of this study was to characterize individual-level longitudinal trajectories of heterogeneity in blood pressure among a Hispanic population with uncontrolled type II diabetes and hypertension enrolled in a multi-level intervention. Methods: This study was implemented along the US-Mexico border. Using blood pressure results collected longitudinally between 2013 and 2020 from 2476 participants with diabetes and high blood pressure at baseline, we conducted group-based trajectory modeling to identify latent groups for systolic blood pressure (SBP). We evaluated participant engagement characteristics and other individual-level characteristics and elucidated how these factors were associated with group membership. Results: We identified four distinct SBP trajectory groups. Three groups demonstrated improvement, two of which had clinically significant changes in SBP that were maintained through 24 months. One group was resistant to SBP improvements despite the intervention. While all groups maintained higher than normal SBP levels, the group characteristics elucidate factors that contribute to improvement or lack thereof. Conclusion: Understanding SBP trajectories in the context of population heterogeneity can inform tailoring approaches undertaken by interventions. These findings inform approaches for clinics to more effectively match screening of non-medical drivers of health to individual patient needs.
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