Utilizing Mobile Health Units for Mass Hypertension Screening in Socially Vulnerable Communities Across Detroit

Nearly half of all adults in the United States have hypertension, defined as a blood pressure (BP) ≥130/80 mm Hg. However, both the prevalence (56%) and control rates (18%) are worse in Black patients.¹ Numerous social determinants of health in socially vulnerable populations further exacerbate these disparities while reducing hypertension awareness and access to health care.² Few places exemplify this crisis like the city of Detroit (78% Black race) where hypertension rates are the highest in Michigan (https://www.cdc.gov/places) and all census tracks are in health professional shortage areas (https://data.hrsa.gov/tools/shortage-area/). As such, the public health importance of large-scale screening efforts to identify the enormous number of individuals with hypertension cannot be over-stated.³ We here describe the first-year results using our novel Wayne Health Mobile Unit program developed in collaboration with Wayne State University to address health disparities in Detroit.⁴

The Wayne Health Mobile Unit program, launched March 2020, comprises a fleet of up-fitted Ford Transit vans staffed with multiple personnel⁴. The initial focus on coronavirus disease 2019 (COVID-19) testing was rapidly expanded to additional health care capabilities given community needs. Five to 7 mobile health units deploy 5 to 6 days per week to 376 available community partner locations covering the Detroit area targeting locations with higher social vulnerability using specialized geocoding methodologies.⁴

Given the large population serviced (while also ensuring resiliency of the program during cold weather and COVID restrictions), we developed a high-throughput method to offer screening for high BP (defined as ≥120/80 mm Hg) beginning in November 2020. Those driving to a site (≈90%) rested inside their parked car for ≥5 minutes. BP was then measured using an Omron 907XL monitor following a guideline-consistent protocol—up to an average of triplicate upper arm readings (1-minute intervals) using a correct cuff size with the arm supported at heart level (door armrest) and feet resting on the car floor. A minority (<10%) of walk-up patients had seated BP measured in mobile health units canopy rooms. As privacy was limited, BP measurements were attended and cuffs were placed over long-sleeves when relevant.

All patients are provided follow-up care in the Wayne Health system per individual needs/wishes. Health information, including prior hypertension status, is collected but not currently available for the entire cohort. Individuals with a screening systolic BP ≥130 mm Hg requiring primary care or social services were invited to enroll into an associated, Center for Disease Control-supported quality improvement program (Bring-it-Down) capturing health information.

As of December 2021, 53 305 unique patient visits had been conducted at ≈1400 events. During the first year of offering BP screening (November 2020 to December 31, 2021), 3040 individuals elected to participate. Roughly 63% of patients had high BP values with nearly one-third in the stage-II hypertension range (Table). Among Bring-It-Down participants (n=143), 42% had no prior diagnosis of hypertension or were unaware of their BP status; whereas 59% had confirmation of clinic follow-up.