OBJECTIVES: Hypertension, a major risk-factor for cardiovascular disease and stroke, is a global public health problem. Effective antihypertensive medication use can decrease morbidity/mortality, yet medication access may vary by factors beyond insurance coverage. We measured educational disparities in hypertension medication access and confidence in hypertension self-management among the elderly with Medicare coverage in the USA.

METHODS: The sample included those age 65 years or older with hypertension in the 2013 Medicare Current Beneficiary Survey (n=6652). We examined satisfaction with access to hypertension medications and confidence in hypertension self-management by education: less than high school, high school graduate, and some college or more (comparison group). Multivariable logistic regression was used to model the outcomes of being very satisfied, or very confident, controlling for age group, gender, income, race/ethnicity, comorbidity, health status, and type of prescription drug coverage (Medicare Part D, private, Medicare Advantage, Medicaid dual eligible, none). Significance was set at p<.05.

RESULTS: For education, 21.1% had less than high school, 35.9% were high school graduates, and 43.0% had at least some college. In multivariable models, having less than a high school education was negatively associated with satisfaction in: the amount paid for medication (OR:0.68; 95%CI:0.56-0.83), the list of drugs covered (OR:0.69; 95%CI:0.56-0.85), and finding a pharmacy that accepted their drug plan (OR:0.58; 95%CI:0.47-0.72), compared to those with some college education. Both those with less than a high school education (OR:0.64; 95%CI: 0.53-0.77) and with a high school degree (OR:0.70; 95%CI:0.62-0.80) were significantly less confident in managing their hypertension than those with some college education.

CONCLUSIONS: This nationally representative sample revealed gaps in access to prescription medications by educational attainment, as well as less confidence in self-management, even after controlling for prescription drug coverage and other sociodemographic factors. Those with low education may lack drug coverage and/or chronic care managment plans that meet their needs.