Primary Care Patients With Substance Use Disorder More Likely to Have Undiagnosed Hypertension and Diabetes

Using electronic health record data from a large, urban US healthcare system, investigators conducted a cross-sectional study comparing rates of undiagnosed hypertension and diabetes in primary care patients with and without substance use disorder (SUD).*

• Of 315,935 patients, only 7991 (3 percent) had documented SUD diagnoses.
• Among patients with SUD, 47 percent had diagnosed hypertension and 3 percent had undiagnosed hypertension; 22 percent had diagnosed diabetes and 12 percent had undiagnosed diabetes.
• Among patients without SUD, 51 percent had diagnosed hypertension and 1 percent had undiagnosed hypertension; 31 percent had diagnosed diabetes and 6 percent had undiagnosed diabetes.
• In adjusted analyses, patients with SUD had greater odds of having undiagnosed hypertension (adjusted odds ratio [aOR], 1.81) and undiagnosed diabetes (aOR, 1.93), compared with those without SUD.
• Having an HIV diagnosis was also independently associated with greater odds of undiagnosed hypertension (aOR, 8.80) and undiagnosed diabetes (aOR, 3.4), compared with patients without an HIV diagnosis.

* Undiagnosed hypertension was defined as having ≥2 blood pressure readings of ≥140/90 without a hypertension diagnosis or being prescribed antihypertensive medication. Undiagnosed diabetes was defined as having a hemoglobin A1c reading ≥6.5 without a diabetes diagnosis or being prescribed diabetes medication. Types of SUD included: “alcohol use, opioid use, cannabis dependence, sedative use, cocaine use, other stimulant use, hallucinogen use, inhalant use, other psychoactive substance use, and unspecified SUD.”

Comments: This sample’s low prevalence of documented SUD highlights the need for better SUD screening in primary care. Furthermore, the association between SUD and undiagnosed medical comorbidities raises questions about the quality of care that these patients receive. Stigma toward patients with SUD among primary care practitioners (PCPs) may contribute to these disparities, but time pressures on PCPs are likely also a factor. As PCPs are increasingly encouraged to treat SUD, interdisciplinary clinical teams and realistic reimbursement models will be necessary to support this work.

Aaron D. Fox, MD

Reference: Lindenfeld Z, Chen K, Kapur S, Chang JE. Comparing rates of undiagnosed hypertension and diabetes in patients with and without substance use disorders. J Gen Intern Med. 2024;39(9):1632–1641.