Henderson Austin, Rosenman Robert, Fyfe-Johnson Amber L, Taniguchi Tori, Standridge Joy, Shackleford Tyra, Muller Clemma J, Umans Jason G, Jernigan Valarie Blue Bird
Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, Washington, United States of America.
School of Economic Sciences, Washington State University, Pullman, Washington, United States of America.
Arch Public Health. 2024 Apr 26;82(1):59. doi: 10.1186/s13690-024-01274-9.
Dietary interventions are used for the treatment of hypertension. We evaluated the cost-efficacy of delivering boxes of healthy, culturally tailored foods and checks that can only be spent on produce in a Native American population.
We conducted a group randomized controlled trial from 2018 to 2020 with N = 2 treatment counties and N = 2 control counties and a total of N = 160 Native American adults with baseline stage 1 or stage 2 hypertension. Participants in the intervention group received monthly boxes of food that adheres to the Dietary Approaches to Stop Hypertension diet as well as checks that could only be spent on produce for 6 months. We measured blood pressure and quality of life at baseline and at a 6-month follow-up in both intervention and control groups. We used ordered logistic regression to estimate the effect of treatment on probability of blood pressure improvements. We then conducted a cost-efficacy analysis.
We found that treatment was effective in reducing blood pressure in women with stage 1 hypertension at baseline. Based on this finding, we also estimate that this intervention satisfies normative cost-effectiveness thresholds, even when lifetime treatment is needed to preserve the impact, so long as treatment is only continued in those who respond to treatment.
Direct delivery of healthy foods and checks that can only be spent on produce are a potentially cost-effective intervention for the management of hypertension among Native American women with stage 1 hypertension. Further research is needed to understand why we found an impact only for this group.
饮食干预用于治疗高血压。我们评估了为美国原住民提供健康的、符合文化习惯的食品盒以及只能用于购买农产品的支票的成本效益。
我们在2018年至2020年进行了一项群组随机对照试验，有2个治疗县和2个对照县，共有160名患有基线1期或2期高血压的美国原住民成年人。干预组的参与者每月收到符合终止高血压饮食方法（DASH饮食）的食品盒以及只能用于购买农产品的支票，为期6个月。我们在基线以及干预组和对照组的6个月随访时测量了血压和生活质量。我们使用有序逻辑回归来估计治疗对血压改善概率的影响。然后我们进行了成本效益分析。
我们发现，治疗对基线时患有1期高血压的女性降低血压有效。基于这一发现，我们还估计，即使需要终身治疗来维持疗效，只要仅对有反应的患者继续治疗，这种干预就能满足标准成本效益阈值。
直接提供健康食品和只能用于购买农产品的支票，对于管理患有1期高血压的美国原住民女性的高血压来说，是一种潜在的成本效益高的干预措施。需要进一步研究来理解为什么我们只在这个群体中发现了疗效。
