County Prevalence and Control of High Blood Pressure from Health Kiosks, 2017-2024

Background As the leading modifiable risk factor for death in the United States, hypertension requires timely and locally detailed surveillance. Current estimates of the high blood pressure (BP) care continuum are lagged national averages from sample surveys with low participation and unknown subnational variation. This study explores the use of self-service health kiosks in retail stores as an alternative source for subnational estimates of prevalence, awareness, and control.

We analyzed data from adult kiosk users (n = 1,270,485) across 1,892 counties in 49 States (except Massachusetts) and District of Columbia in a serial cross-sectional analysis from November 2017 to September 2024. High BP was defined as self-reported diagnosed or elevated BP (systolic ≥140 mmHg or diastolic ≥90 mmHg). Among those diagnosed, control was defined as BP <140/90 mmHg. Small area estimates for counties were calculated using multilevel regression and poststratification based on individual and areal socio-demographic covariates. We compared the prevalence of diagnosed hypertension with the Behavioral Risk Factor Surveillance System 2021.

The analytic sample had a mean age of 42.0 years (SD=15.6). Prevalence of high BP was 51.9% in 2017-2018 and 50.4% in 2023-2024. In 2023-2024, awareness and control were 73.7% and 61.8% and county-level prevalence ranged from 39.5% to 63.1%. Similar hotspots in the Southeast were identified in both kiosk and BRFSS (Spearman’s ρ = 0.52).

Health kiosk data reveal substantial spatial and socio-demographic variation in high BP. Near real-time sub-national surveillance of health kiosk users can provide insights to guide interventions and track progress. What is New? - Self-service health kiosk data complement national surveys by offering direct BP measurements with wider geographic coverage and higher representation of vulnerable populations. - This study provides recent state- and county- level estimates of prevalence, awareness, and control of high BP for 1.3 million kiosk users. What is Relevant? - In 2023-2024, prevalence of high BP among kiosk users exceeded 50.0% with county- level variation ranging from 39.5% in the Mountain West to 63.1% in the Southeast. - National awareness and control were suboptimal at 73.7% and 61.8%. - These results highlight persistent gaps in high BP detection and management. Clinical/Pathophysiological Implications? - Near real-time kiosk-based BP surveillance can help identify high-risk populations and administer timely interventions to reduce cardiovascular risk. Competing Interest Statement Lauren Fede and Cameron Gocke are employees of Pursuant Health. Funding Statement None Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institutional Review Board of Emory University waived ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Sources of Support: None Abbreviations: BRFSS: Behavioral Risk Factor Surveillance System, CDC: Centers for Disease Control & Prevention, NHANES: National Health and Nutrition Examination Surveys, PLACES: Local Data for Better Health, SMART: Selected Metropolitan/Micropolitan Area Risk Trends Data availability statement The proprietary data used in this manuscript is available upon signing a data use agreement and at the discretion of Pursuant Health LLC. The code and data used to generate figures and tables are available at https://github.com/jvargh7/spatial_kiosks.