Atkinson Jheanelle A, Carmichael Suzan L, Leonard Stephanie A
School of Medicine, Meharry Medical College, Nashville, TN, USA.
Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
J Racial Ethn Health Disparities. 2024 Nov 5. doi: 10.1007/s40615-024-02224-5.
Black individuals carry the greatest burden of maternal mortality, with hypertensive disorders during pregnancy being a significant driving force to this disparity. However, research on maternal health disparities predominantly groups Hispanic Black individuals with all other individuals of Hispanic ethnicity. We hypothesized that this aggregation might obscure the risk patterns of hypertensive disorders in pregnancy for Hispanic-Black and non-Hispanic Black individuals.
We analyzed a California statewide dataset of vital records linked to hospitalization discharge data for births from 2007 to 2018. Using multivariable logistic regression models adjusted for age, pre-pregnancy BMI, parity, smoking status, diabetes, and chronic renal disease, we compared the odds of hypertensive disorders in pregnancy between Hispanic Black, non-Hispanic Black, and non-Black Hispanic racial-ethnic groups. Hypertensive disorders were categorized into two groups: (1) any hypertensive disorder and (2) chronic hypertension alone, non-severe hypertensive disorders, and severe hypertensive disorders in pregnancy.
Non-Hispanic Black people had 75% increased odds of developing a hypertensive disorder during pregnancy (adjusted odds ratio (aOR); 95% confidence interval (CI): 1.74, 1.78) and Hispanic-Black individuals had a 31% increased odds (95% CI: 1.24, 1.38) as compared with non-Black Hispanic individuals. When considering hypertensive disorders separately, the race-associated differences were largest for chronic hypertension alone, with non-Hispanic Black individuals showing an aOR of 2.35 (95% CI: 2.32, 2.38) and Hispanic-Black individuals an aOR of 1.80 (95% CI: 1.66, 1.95).
Compared with non-Black Hispanic individuals, the prevalence of hypertensive disorders in pregnancy was higher in Black-Hispanic individuals and highest in non-Hispanic Black individuals. Racial/ethnic differences were larger for chronic hypertension alone than for preeclampsia.
黑人个体承担着孕产妇死亡的最大负担，孕期高血压疾病是造成这种差异的一个重要驱动因素。然而，关于孕产妇健康差异的研究主要将西班牙裔黑人个体与所有其他西班牙裔种族的个体归为一组。我们推测，这种归类可能会掩盖西班牙裔黑人个体和非西班牙裔黑人个体孕期高血压疾病的风险模式。
我们分析了加利福尼亚州一个全州范围的数据集，该数据集将2007年至2018年出生的住院出院数据与生命记录相链接。使用针对年龄、孕前体重指数、产次、吸烟状况、糖尿病和慢性肾病进行调整的多变量逻辑回归模型，我们比较了西班牙裔黑人、非西班牙裔黑人以及非黑人西班牙裔种族群体孕期高血压疾病的患病几率。高血压疾病分为两组：（1）任何高血压疾病；（2）仅慢性高血压、非重度高血压疾病以及孕期重度高血压疾病。
与非黑人西班牙裔个体相比，非西班牙裔黑人个体孕期患高血压疾病的几率增加了75%（调整后的优势比（aOR）；95%置信区间（CI）：1.74，1.78），西班牙裔黑人个体的几率增加了31%（95%CI：1.24，1.38）。当分别考虑高血压疾病时，仅慢性高血压的种族相关差异最大，非西班牙裔黑人个体的aOR为2.35（95%CI：2.32，2.38），西班牙裔黑人个体的aOR为1.80（95%CI：1.66，1.95）。
与非黑人西班牙裔个体相比，西班牙裔黑人个体孕期高血压疾病的患病率更高，非西班牙裔黑人个体的患病率最高。仅慢性高血压的种族/族裔差异比子痫前期的差异更大。
