Racial disparities in CV outcomes evident among pregnant, postpartum Black women
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Among pregnant and postpartum women, Black women remained at increased risk for mortality and stroke compared with white women despite trends for improved CV outcomes, researchers reported.
“We found that racial disparities ... persisted after adjusting for socioeconomic factors and access to health care,” Mohamed M. Gad, MD, resident in the department of internal medicine at Cleveland Clinic Foundation, and colleagues wrote. “Our study showed that Black women are at a significant risk of mortality and cardiovascular events with certain cardiovascular events, acute MI and pulmonary embolism increasing over the study duration disproportionately compared with white women. Many studies entreat socioeconomic differences as the leading contributor to racial disparities as the average Black female has a lower household income, educational attainment and access to health care.”
For this study published in the Journal of the American Heart Association, researchers used the Nationwide Inpatient Sample to identify pregnant and postpartum women who were hospitalized from 2007 to 2017 and evaluated the association between race and major CV events during pregnancy. Outcomes included in-hospital mortality, MI, stroke, pulmonary embolism and peripartum cardiomyopathy.
Among 46,700,637 pregnancy-related hospitalizations, 46.4% were white patients, 13.5% were Black, 19.1% were Hispanic and 4.8% were Asian/Pacific Islander.
According to the study, trends for mortality and stroke declined significantly among Black women but were mostly unchanged among white women during the 10-year period.
Black women experienced greater risk for complications such as bleeding, cardiac tamponade, cardiac arrest, acute kidney injury and sepsis compared with any other race/ethnicity (P for all < .001).
After adjustment for socioeconomic status, access to health care and comorbidities, Black women experienced the most in-hospital mortality (adjusted OR = 1.45; 95% CI, 1.21-1.73; P < .001), acute MI (aOR = 1.23; 95% CI, 1.06-1.42; P = .006), stroke (aOR = 1.57; 95% CI, 1.41-1.74; P < .001), PE (aOR = 1.42; 95% CI, 1.3-1.56; P < .001) and peripartum cardiomyopathy (aOR = 1.71; 95% CI, 1.66-1.76; P < .001) of any other race/ethnicity compared with white women.
“The magnitude of disparity was most alarming,” Samir R. Kapadia, MD, chair of the department of cardiovascular medicine at the Cleveland Clinic, said in a press release. “We were very surprised by the persistent disparities irrespective of socioeconomic status. Attributing worse outcomes in Black women to socioeconomic status or differences in health care delivery may be an oversimplification.”
Researchers also observed that 62.3% of Black women were insured by Medicaid, while 61.9% of white women had private insurance. In addition, 71.2% of Black women were below the median income range, whereas 52.7% of white women were above the median income range.
“Programs targeted at reducing racial disparities should consider cultural factors affecting certain behaviors and disease prevalence as culturally tailored interventions influence behaviors in a more favorable way preventing modifiable risk factors,” the researchers wrote. “Further studies are needed to provide a cost-benefit analysis demonstrating the impact of primary and secondary preventive measures on direct and indirect financial costs associated with cardiovascular events and mortality in pregnancy.”
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