Racial, ethnic disparities persist in maternal CV outcomes
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Black women had higher rates of CV hospitalization, maternal morbidity and maternal mortality than white women within 1 year of delivery, according to a research letter published in Circulation: Cardiovascular Quality and Outcomes.
“While it has been previously recognized that Black women are at increased risk for heart failure due to peripartum cardiomyopathy, this study adds to the body of evidence that Black women are also at the highest risk for postpartum morbidity due to a large umbrella of cardiovascular conditions including myocardial infarction, stroke, venous thromboembolism and arrhythmia,” Zainab, Mahmoud, MDMSc, a cardiology fellow at Washington University in St. Louis, and colleagues wrote.
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In a study analyzing 3,269,768 unique patient-delivery hospitalizations (47.8% white, 18.6% Black, 19.5% Hispanic, 14.1% other races) from the New York and Florida Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 2006 to 2017, Mahmoud and colleagues examined the disparities in maternal CV outcomes by race/ethnicity.
The primary outcome was any CV hospitalization within 1 year of delivery, whereas specific types of CV hospitalizations were the secondary outcomes.
After adjustment for medical comorbidities, area income quartile and insurance, compared with white women, Black women were more likely to have a CV hospitalization within a year of delivery, at a rate of 0.72% vs. 0.33% (adjusted HR = 1.6; 95% CI, 1.53-1.67).
For the secondary outcomes, Black women were also more likely to have acute MI (aHR = 1.31; 95% CI, 1.02-1.66), HF (aHR = 1.94; 95% CI, 1.82-2.08), stroke (aHR = 1.41; 95% CI, 1.25-1.58), VTE (aHR = 1.31; 95% CI, 1.22-1.4) and arrhythmia (aHR = 1.68; 95% CI, 1.37-2.06) compared with white women.
Compared with white women, Hispanic women had lower risk for all CV hospitalizations (aHR = 0.8; 95% CI, 0.76-0.84), acute MI (aHR = 0.62; 95% CI, 0.46-0.85), HF (aHR = 0.75; 95% CI, 0.68-0.82), VTE (aHR = 0.74; 95% CI, 0.68-0.81) and arrhythmia (aHR = 0.77; 95% CI, 0.59-0.99), according to the researchers.
“These significant inequities may be mediated through inadequate medical coverage and care between pregnancies, systemic, structural, and individual racism and bias, and worse chronic cardiovascular health,” Mahmoud and colleagues wrote. “Enhanced postpartum monitoring, as well as efforts focused on improving access to care, multidisciplinary care models to manage chronic medical conditions during pregnancy, and policies that directly address racism and bias may be key strategies for improving maternal cardiovascular outcomes in this population.”
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