Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 2, 2025
Date Accepted: Nov 19, 2025
The Effect of Veteran Race and Socioeconomic Status on Enrollment in Remote Patient Monitoring for Hypertension: A Retrospective Observational Cross Sectional Study
ABSTRACT
Background:
Black Veterans and Veterans from lower socioeconomic backgrounds are more likely to have uncontrolled hypertension. The Veteran’s Health Administration (VHA) offers a remote patient monitoring (RPM) program for patients with hypertension, consisting of patient education, daily home blood pressure (BP) monitoring, health coaching and case management; however barriers may exist for minoritized and economically disadvantaged Veterans.
Objective:
The objective of this study was to assess the relationship between Veteran race and neighborhood socioeconomic status and RPM enrollment.
Methods:
The study sample included 2.3 million person-years across 1.3 million VHA-enrolled Veterans with a diagnosis of hypertension (Average BP>130/80 mmHG on ≥2 BP readings) between fiscal year 2020-2023. We ran random-effects logistic regression models to assess the relationship between Veteran race and area deprivation index (ADI) score and RPM enrollment each year, controlling for potential demographic and clinical confounders. For sensitivity analysis, we limited our sample to Veterans with stage/grade 2 (BP>140/90 mmHG) and hypertensive medication use.
Results:
Overall utilization of RPM was low, with only 2.1% of Black Veterans were more likely (Odds Ratio [OR]: 1.64, 95% confidence interval [CI]: 1.59-1.70) to enroll in RPM compared to White Veterans. We found no meaningful association between ADI and enrollment in RPM (OR:0.99, 95% CI: 0.99-1.00). Limiting our sample to those with stage/grade 2 hypertension, we found a smaller but still significant association (OR: 1.59, 95% CI: 1.48-1.70) between Black race and RPM enrollment. Veterans with more comorbidities, with diabetes, and with hypertension with complications were all more likely to enroll in RPM.
Conclusions:
We found no evidence of racial disparity in RPM, but did find higher enrollment rates among Black Veterans. Future research will assess the effectiveness of RPM in improving hypertension control across all Veteran populations.
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