Division of Cardiology, Department of Medicine University of Pittsburgh Medical Center Pittsburgh PA USA.
Lifespan Cardiovascular Institute, Warren Alpert Medical School of Brown University Providence RI USA.
J Am Heart Assoc. 2024 Aug 20;13(16):e033188. doi: 10.1161/JAHA.123.033188. Epub 2024 Aug 7.
Preeclampsia is associated with increased cardiovascular morbidity and death. Primary care or cardiology follow-up, in complement to routine postpartum obstetric care, provides an essential opportunity to address cardiovascular risk. Prior studies investigating racial differences in the recommended postpartum follow-up have incompletely assessed the influence of social factors. We hypothesized that racial and ethnic differences in follow-up with a primary care provider or cardiologist would be modified by income and education.
We identified adult individuals with preeclampsia (September 2014 to September 2019) in a national administrative database. We compared occurrence of a postpartum visit with a primary care provider or cardiologist within 1 year after delivery by race and ethnicity using multivariable logistic regression models. We examined whether education or income modified the association between race and ethnicity and the likelihood of follow-up. Of 18 050 individuals with preeclampsia (aged 31.8±5.7 years), Black individuals (11.7%) had lower odds of primary care provider or cardiology follow-up within 1 year after delivery compared with White individuals (adjusted odds ratio, 0.77 [95% CI, 0.70-0.85]) as did Hispanic individuals (14.8%; adjusted odds ratio, 0.79 [95% CI, 0.73-0.87]). Black and Hispanic individuals with higher educational attainment were more likely to have follow-up than those with lower educational attainment ( for interaction=0.033) as did those in higher income brackets ( for interaction=0.006).
We identified racial and ethnic differences in primary care or cardiology follow-up in the year postpartum among individuals diagnosed with preeclampsia, a disparity that may be modified by social factors. Enhanced system-level interventions are needed to reduce barriers to follow-up care.
子痫前期与心血管发病率和死亡率增加有关。初级保健或心脏病学随访，与常规产后产科护理相辅相成，为解决心血管风险提供了一个重要机会。先前研究调查了推荐的产后随访中种族差异，这些研究没有充分评估社会因素的影响。我们假设，在与初级保健提供者或心脏病专家的随访方面，种族和民族差异会因收入和教育水平而改变。
我们在一个国家行政数据库中确定了患有子痫前期的成年个体（2014 年 9 月至 2019 年 9 月）。我们使用多变量逻辑回归模型比较了种族和民族在产后 1 年内与初级保健提供者或心脏病专家进行产后就诊的发生率。我们检查了教育或收入是否改变了种族和民族与随访可能性之间的关联。在 18050 名患有子痫前期的个体（年龄 31.8±5.7 岁）中，黑人（11.7%）在产后 1 年内接受初级保健提供者或心脏病专家随访的可能性低于白人（调整后的优势比，0.77[95%CI，0.70-0.85]），西班牙裔（14.8%）也是如此（调整后的优势比，0.79[95%CI，0.73-0.87]）。教育程度较高的黑人和西班牙裔个体更有可能接受随访，而教育程度较低的个体则不太可能接受随访（交互作用 P=0.033），收入较高的个体也是如此（交互作用 P=0.006）。
我们在患有子痫前期的个体中发现了产后 1 年内初级保健或心脏病学随访方面的种族和民族差异，这种差异可能会因社会因素而改变。需要增强系统层面的干预措施，以减少随访护理的障碍。
