Publication Date

1-5-2021

Journal

Journal of the American Heart Association

DOI

10.1161/JAHA.120.017832

PMID

33322915

PMCID

PMC7955477

PubMedCentral® Posted Date

12-16-2020

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Adult, Cardiovascular Diseases, Demography, Female, Health Services Needs and Demand, Health Status Disparities, Healthcare Disparities, Hospital Mortality, Hospitalization, Humans, Incidence, Medicaid, Pregnancy, Pregnancy Complications, Cardiovascular, Puerperal Disorders, Socioeconomic Factors, United States, cardiovascular mortality, disparities in care, health inequities, pregnancy, Quality and Outcomes, Pregnancy, Race and Ethnicity

Abstract

Background

The incidence of cardiovascular disease among pregnant women is rising in the United States. Data on racial disparities for the major cardiovascular events during pregnancy are limited.

Methods and Results

Pregnant and post‐partum women hospitalized from January 2007 to December 2017 were identified from the Nationwide Inpatient Sample. The outcomes of interest included: in‐hospital mortality, myocardial infarction, stroke, pulmonary embolism, and peripartum cardiomyopathy. Multivariate regression analysis was used to assess the independent association between race and in‐hospital outcomes. Among 46 700 637 pregnancy‐related hospitalizations, 21 663 575 (46.4%) were White, 6 302 089 (13.5%) were Black, and 8 914 065 (19.1%) were Hispanic. The trends of mortality and stroke declined significantly in Black women, but however, were mostly unchanged among White women. The incidence of mortality and cardiovascular morbidity was highest among Black women followed by White women, then Hispanic women. The majority of Blacks (62.3%) were insured by Medicaid while the majority of White patients had private insurance (61.9%). Most of Black women were below‐median income (71.2%) while over half of the White patients were above the median income (52.7%). Compared with White women, Black women had the highest mortality with adjusted odds ratio (aOR) of 1.45, 95% CI (1.21–1.73); myocardial infarction with aOR of 1.23, 95% CI (1.06–1.42); stroke with aOR of 1.57, 95% CI (1.41–1.74); pulmonary embolism with aOR of 1.42, 95% CI (1.30–1.56); and peripartum cardiomyopathy with aOR of 1.71, 95 % CI (1.66–1.76).

Conclusions

Significant racial disparities exist in major cardiovascular events among pregnant and post‐partum women. Further efforts are needed to minimize these differences.

Comments

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