Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Pennsylvania, Philadelphia, PA.
Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Am Heart J. 2021 Aug;238:27-32. doi: 10.1016/j.ahj.2021.03.015. Epub 2021 Apr 19.
Peripartum cardiomyopathy (PPCM) disproportionately affects women of African ancestry. Additionally, clinical outcomes are worse in this subpopulation compared to White women with PPCM. The extent to which socioeconomic parameters contribute to these racial disparities is not known.
We aimed to quantify the association between area-based proxies of socioeconomic status (SES) and clinical outcomes in PPCM, and to determine the potential contribution of these factors to racial disparities in outcomes. A retrospective cohort study was performed at the University of Pennsylvania Health System, a tertiary referral center serving a population with a high proportion of Black individuals. The cohort included 220 women with PPCM, 55% of whom were Black or African American. Available data included clinical and demographic characteristics as well as residential address georeferenced to US Census-derived block group measures of SES. Rates of sustained cardiac dysfunction (defined as persistent LVEF <50%, LVAD placement, transplant, or death) were compared by race and block group-level measures of SES, and a composite neighborhood concentrated disadvantage index (NDI). The contributions of area-based socioeconomic parameters to the association between race and sustained cardiac dysfunction were quantified.
Black race and higher NDI were both independently associated with sustained cardiac dysfunction (relative risk [RR] 1.63, confidence interval [CI] 1.13-2.36; and RR 1.29, CI 1.08-1.53, respectively). Following multivariable adjustment, effect size for NDI remained statistically significant, but effect size for Black race did not. The impact of low neighborhood education on racial disparities in outcomes was stronger than that of low neighborhood income (explaining 45% and 0% of the association with black race, respectively). After multivariate adjustment, only low area-based education persisted as significantly correlating with sustained cardiac dysfunction (RR 1.49; CI 1.02-2.17).
Both Black race and NDI independently associate with adverse outcomes in women with PPCM in a single center study. Of the specific components of NDI, neighborhood low education was most strongly associated with clinical outcome and partially explained differences in race. These results suggest interventions targeting social determinants of health in disadvantaged communities may help to mitigate outcome disparities.
围产期心肌病（PPCM）在非裔美国女性中发病率不成比例。此外，与患有 PPCM 的白人女性相比，该人群的临床结局更差。社会经济参数在多大程度上导致了这些种族差异尚不清楚。
我们旨在量化基于区域的社会经济地位（SES）指标与 PPCM 临床结局之间的关联，并确定这些因素对结局种族差异的潜在贡献。这是一项在宾夕法尼亚大学健康系统进行的回顾性队列研究，该系统是一家为高比例黑人服务的三级转诊中心。该队列包括 220 名 PPCM 女性，其中 55%为黑人或非裔美国人。可获得的数据包括临床和人口统计学特征以及居住地址，这些地址已通过美国人口普查衍生的街区组 SES 措施进行地理参考。通过种族和街区组 SES 措施以及综合邻里集中劣势指数（NDI）比较持续心功能障碍（定义为持续 LVEF<50%、LVAD 放置、移植或死亡）的发生率。量化了基于区域的社会经济参数对种族与持续心功能障碍之间关联的贡献。
黑人种族和更高的 NDI 均与持续心功能障碍独立相关（相对风险 [RR] 1.63，置信区间 [CI] 1.13-2.36；RR 1.29，CI 1.08-1.53）。在多变量调整后，NDI 的效应大小仍然具有统计学意义，但黑人种族的效应大小没有。低邻里教育对结局种族差异的影响强于低邻里收入（分别解释与黑人种族关联的 45%和 0%）。在多变量调整后，只有低区域教育仍然与持续心功能障碍显著相关（RR 1.49；CI 1.02-2.17）。
在一项单中心研究中，黑人种族和 NDI 均与 PPCM 女性的不良结局独立相关。在 NDI 的具体组成部分中，邻里低教育与临床结局的关联最强，并部分解释了种族差异。这些结果表明，针对弱势社区健康的社会决定因素的干预措施可能有助于缓解结局差异。
