Poster Session 3
Category: Hypertension
Poster Session 3
Carolyn N. Rocha, MD
Department of Obstetrics and Gynecology, Los Angeles General Medical Center
Los Angeles, California, United States
Yadira L. Bribiesca Leon, MD, MPH (she/her/hers)
Resident
Keck School of Medicine of USC, University of Southern California
Los Angeles, California, United States
Zaira N. Chavez Jimenez, MD
Department of Obstetrics and Gynecology, Los Angeles General Medical Center
Los Angeles, California, United States
Fay F. Pon, MD
Department of Obstetrics and Gynecology, Los Angeles General Medical Center
Los Angeles, California, United States
Sawa Keymeulen, MD
Department of Obstetrics and Gynecology, Los Angeles General Medical Center
Los Angeles, California, United States
Ariane C. Youssefzadeh, MD
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California
Los Angeles, California, United States
Nicole M. Chadwick, MD
Department of Obstetrics and Gynecology, Los Angeles General Medical Center
Los Angeles, California, United States
Joseph G. Ouzounian, MBA, MD
Professor and Chair of Obstetrics & Gynecology
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California
Los Angeles, California, United States
Koji Matsuo, MD, PhD
Department of Obstetrics and Gynecology, Los Angeles General Medical Center
Los Angeles, California, United States
To assess the incidence of preeclampsia with severe features (SPE) across race and ethnicity groups according to socio-economic status.
Study Design:
This cross-sectional study queried the Agency for Health Healthcare Cost and Utilization Project’s National Inpatient Sample. Study population included 19,907,373 hospital deliveries from 2016-2022. Exposure was race and ethnicity, grouped as White, Black, Hispanic, Asian, and Native American. The outcome measure was diagnosis of SPE. A multivariable generalized linear model was used to assess the exposure-outcome association, adjusted for maternal age, year of delivery, clinical risk factors for preeclampsia (pregestational hypertension, diabetes mellitus, and obesity), and hospital parameters (location and teaching status, and region). The exposure-outcome association was assessed according to socio-economic status based on the combination of census-level median household income (every quartile) and primary payer (private, Medicaid, and self-pay).
Results:
Across the census-level median household income and primary payer strata, both Black and Native American people were more likely to have a diagnosis of SPE (Table). The effect sizes of developing SPE for Black people compared to White people were similar across the socio-economic strata for private insurance (adjusted rate ratio, 1.76, 1.66, 1.58, and 1.61 for >75%ile, 51-75%ile, 26-50%ile, and ≤25%ile census-level median household income groups, respectively) as well as for Medicaid insurance (adjusted rate ratio, 1.68, 1.55, 1.60, and 1.60 for >75%ile, 51-75%ile, 26-50%ile, and ≤25%ile census-level median household income groups, respectively). Results were similar for Native American people (Table).
Conclusion:
Race and ethnicity-specific differences in rates of SPE incidence were similar across socio-economic status. This suggests the development of SPE may be driven by a combination of social drivers of health, structural racism within the medical system, and biologic factors. Further research is needed to identify the drivers of SPE to reduce incidence and improve outcomes.