All ETDs from UAB

Advisory Committee Chair

Shakia T Hardy

Advisory Committee Members

George Howard

Byron Jaeger

Emily Levitan

Paul Muntner

Suzanne Oparil

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


Black adults in the US have 2 to 3 times higher rates of cardiovascular disease (CVD) mortality compared to White adults. Most of the excess CVD mortality in Black adults has been attributed to their higher prevalence of hypertension and uncontrolled blood pressure (BP). In October 2020, the US Surgeon General published a Call-to-Action to improve hypertension control and identified social determinants of health (SDOH) as a major contributor to Black:White disparities in hypertension control. Prior research has showed that SDOH are associated with excess hypertension risk among Black compared with White adults, but data on their association with BP control are limited. In addition, few data are available on the association of SDOH with apparent treatment resistant hypertension (aTRH, the need for ≥4 classes of antihypertensive medications to achieve controlled BP). The goal of this dissertation was to (1) Examine the association of SDOH with uncontrolled BP among Black and White adults taking antihypertensive medication; (2) Determine the proportion of the excess prevalence of uncontrolled BP among Black compared to White adults taking antihypertensive medication that can be attributed to SDOH; (3) Determine the contribution of SDOH to the excess risk of incident aTRH among Black compared to White adults. Among both White (n=7,306) and Black adults (n=7,497) in the Reasons for Geographic And Racial Differences in Stroke study, SDOH including education, annual household income, neighborhood socioeconomic status, high-poverty zip code, lack of health insurance, and iv living in a health professional shortage area were each associated with uncontrolled BP. Combined, all SDOH included in the current analysis explained 33.0% of the excess likelihood of uncontrolled BP among Black compared with White adults. Among both White (n=2,774) and Black adults (n=2,257), low education (14.2%), low income (16.0%), not seeing a relative or friend in the past month (8.1%), not having anyone to care for you if ill (7.6%), living in a disadvantaged neighborhood (18.0%) and lack of health insurance (10.6%) mediated the excess aTRH risk among Black compared with White adults. Addressing SDOH could reduce racial disparities in uncontrolled BP and ultimately the excess CVD risk among Black adults.

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