Heo Moonseong, Rea Corinna J, Brady Tammy M, Bundy David G, Melikam Ezinne Sylvia, Orringer Kelly, Tarini Beth A, Giuliano Kimberly, Twombley Katherine, Goilav Beatrice, Kelly Peterkaye, Faith Myles S, Pietrobelli Angelo, Rinke Michael L
Department of Public Health Sciences, College of Social, Behavioral and Public Health Sciences, Clemson University, Clemson, South Carolina.
Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2025 Jan 2;8(1):e2456238. doi: 10.1001/jamanetworkopen.2024.56238.
Pediatric obesity and hypertension are highly correlated. To mitigate both conditions, provision of counseling on nutrition, lifestyle, and weight to children with high blood pressure (BP) measurements is recommended.
To examine racial and ethnic disparities in receipt of nutrition, lifestyle, and weight counseling among patients with high BP at pediatric primary care visits stratified by patients' weight status.
DESIGN, SETTING, AND PARTICIPANTS: This was a post hoc secondary analysis of the BP-CATCH study, a matched, stepped-wedge cluster randomized clinical trial investigating the best methods to screen children with high BP measurements and manage their care. Urban, suburban, and rural pediatric primary care practices across the US with a multidisciplinary team of at least 1 physician, 1 nurse and another practice associate, and a hypertension specialist for their practice group submitted baseline data from clinical encounters documented between November 2018 and January 2019. Practices identified the first 17 eligible patients with high BP measurements each month. This analysis was conducted from October 2023 to July 2024.
Race and ethnicity (Black, Hispanic, White, and other [Asian, multiracial, other races, and unknown race]) and weight status (with or without obesity).
Primary outcomes were receipt of counseling on nutrition, lifestyle, and weight during primary care visits. Baseline measures extracted from medical records included demographics, anthropometric measures, and systolic and diastolic BP.
Of 2677 participants from 59 practices, 1516 (56.6%) were male; mean (SD) age was 10.8 (5.2) years. A total of 593 (21.1%) were Black; 414 (15.5%), Hispanic; 1111 (41.5%), White; and 559 (20.9%), other race and ethnicity. The overall crude unadjusted rates of receiving counseling were 63.5% (n = 1564 of 2463) for nutrition, 57.6% (n = 1419 of 2462) for lifestyle, 47.5% (n = 571 of 1202) for weight, and 46.4% (n = 1142 of 2461) for all counseling topics. Compared with the other 3 groups, Hispanic participants received significantly higher adjusted rates of nutrition (78.6%; 95% CI, 73.5%-83.8%), lifestyle (69.3%; 95% CI, 63.6%-74.9%), and all 3 (52.1%; 95% CI, 46.1%-58.2%) counseling topics. There were no significant differences in rates of receiving weight counseling between any pairs of groups. These findings were consistent in general among participants without obesity, and no significant pairwise differences were noted among participants with obesity except that nutrition counseling rates were significantly different between White participants and those reporting other race and ethnicity (68.3% [95% CI, 61.1%-75.4%] vs 81.6% [95% CI, 74.2%-89.1%]; Bonferroni-corrected P = .02).
This secondary analysis of the BP-CATCH trial found that among children with high BP measurements, racial and ethnic disparities in receiving nutrition, lifestyle, and all 3 counseling topics were significant, although no significant disparities in receipt of weight counseling were noted. Racial disparities in receipt of counseling were not observed in participants with and without obesity.
ClinicalTrials.gov Identifier: NCT03783650.
儿童肥胖与高血压高度相关。为缓解这两种情况，建议为血压测量值高的儿童提供营养、生活方式和体重方面的咨询。
研究在儿科初级保健就诊时，按患者体重状况分层的高血压患者在接受营养、生活方式和体重咨询方面的种族和民族差异。
设计、背景和参与者：这是对BP-CATCH研究的事后二次分析，BP-CATCH研究是一项匹配的、阶梯式楔形整群随机临床试验，旨在研究筛查血压测量值高的儿童并管理其护理的最佳方法。美国城市、郊区和农村的儿科初级保健机构，拥有至少1名医生、1名护士和另一名执业助理的多学科团队，以及为其执业组配备的高血压专科医生，提交了2018年11月至2019年1月期间记录的临床诊疗基线数据。各机构每月确定首批17名符合条件的血压测量值高的患者。该分析于2023年10月至2024年7月进行。
种族和民族（黑人、西班牙裔、白人以及其他[亚洲人、多种族、其他种族和种族不明]）和体重状况（有或无肥胖）。
主要结局是在初级保健就诊期间接受营养、生活方式和体重方面的咨询。从病历中提取的基线测量指标包括人口统计学信息、人体测量指标以及收缩压和舒张压。
来自59个机构的2677名参与者中，1516名（56.6%）为男性；平均（标准差）年龄为10.8（5.2）岁。共有593名（21.1%）为黑人；414名（15.5%）为西班牙裔；1111名（41.5%）为白人；559名（20.9%）为其他种族和民族。接受咨询的总体粗未调整率分别为：营养咨询63.5%（2463名中的1564名）、生活方式咨询57.6%（2462名中的1419名）、体重咨询47.5%（1202名中的571名）以及所有咨询主题46.4%（2461名中的1142名）。与其他3组相比，西班牙裔参与者接受营养咨询（78.6%；95%置信区间，73.5%-83.8%）、生活方式咨询（69.3%；95%置信区间，63.6%-74.9%）以及所有3项咨询主题（52.1%；95%置信区间，46.1%-58.2%）的调整率显著更高。各组之间接受体重咨询的比率无显著差异。这些发现在无肥胖参与者中总体一致，在肥胖参与者中除白人参与者与报告其他种族和民族的参与者之间营养咨询率存在显著差异外（68.3%[95%置信区间，61.1%-75.4%]对81.6%[95%置信区间，74.2%-89.1%]；经邦费罗尼校正的P=0.02），未观察到显著的两两差异。
对BP-CATCH试验的这项二次分析发现，在血压测量值高的儿童中，接受营养、生活方式和所有3项咨询主题方面存在显著的种族和民族差异，尽管在接受体重咨询方面未观察到显著差异。在有肥胖和无肥胖的参与者中均未观察到接受咨询方面的种族差异。
ClinicalTrials.gov标识符：NCT03783650。
