Abstract
BACKGROUND: Access to a primary care physician (PCP) is essential for managing chronic diseases. Limited PCP access in underserved populations can lead to undiagnosed or poorly managed hypertension. This cross-sectional study assessed the association between having a PCP and uncontrolled blood pressure (BP) among predominantly Hispanic or Latino attendees of a community health fair, adjusting for identified confounders. METHODS: Data were collected from participants aged 18 years or older at Fiesta de Salud, a community health fair held in Yakima County, Washington State, in August 2023. Blood pressure, PCP status, insurance coverage, demographics, and self-reported hypertension diagnoses were recorded. Uncontrolled BP was defined as systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg. Bivariate analyses utilized Pearson's chi-squared tests. Variable selection for adjusted robust Poisson regression was informed by a directed acyclic graph (DAG), subsequently adjusting for demographics (gender and age), socioeconomic (insurance status), and clinical (prior hypertension diagnosis) confounders. Only complete cases were included for analysis. RESULTS: Of the 218 participants analyzed, 84% identified as Hispanic, 63% were female. Uncontrolled BP prevalence was 33%. Participants without a PCP had significantly higher prevalence of uncontrolled BP (59% vs. 42%, p = 0.002). Having a PCP consistently lowered the prevalence of uncontrolled BP across all models, remaining significant in the fully adjusted model (PR = 0.54; 95% CI: 0.35-0.85, p = 0.007). Adjustment variables identified by the DAG were included to reduce confounding. CONCLUSIONS: Having a PCP was independently associated with better BP control after adjusting for demographic, socioeconomic, and clinical confounders. Expanding access to consistent PCP relationships, particularly in underserved communities, may improve hypertension management and reduce disparities. Community health fairs can play an important role by identifying individuals with uncontrolled blood pressure and facilitating linkage to ongoing primary care.