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.
Included in
Cardiology Commons, Cardiovascular Diseases Commons, Medical Sciences Commons, Obstetrics and Gynecology Commons, Race and Ethnicity Commons, Women's Health Commons
Comments
Associated Data