Abstract MP66: Social Determinants And Co-morbid Conditions In Women Of Child-bearing Age With Hypertension From 2001-2018

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Lara C Kovell ◽  
Claire Meyerovitz ◽  
Didem Ayturk ◽  
Stephen P Juraschek ◽  
Tiffany A Moore Simas ◽  
...  
Keyword(s):  
Black Women ◽  
Social Determinants ◽  
White Women ◽  
Hispanic Women ◽  
Private Insurance ◽  
Anthropometric Measures ◽  
Mortality And Morbidity ◽  
Child Bearing ◽  
Race Ethnicity ◽  
Morbid Conditions

Introduction: Hypertension (HTN) is the most important modifiable risk factor of serious maternal mortality and morbidity. Social determinants, including economic stability and access to healthcare, influence HTN outcomes and are critical to understanding and addressing racial and ethnic differences in HTN control. Objective: To assess social determinants and co-morbidities in US women of child-bearing age with HTN by race/ethnicity Methods: We studied women (age 20-50) with HTN in the National Health and Nutrition Examination Surveys 2001-2018. Social determinants and co-morbid conditions were examined in groups categorized by race/ethnicity - Non-Hispanic White (White), Non-Hispanic Black (Black), and Hispanic. Demographics, anthropometric measures, and co-morbid conditions were compared with White women as reference. Results: In all women with HTN, the mean (SE) age was 36.0 (0.3) years and 63% were on BP medication. Compared to white women, Black and Hispanic women had lower food security, poverty income ratio, smoking use, and private insurance (all p<0.0001, Table ). Black women had higher BP medication use, BMI, and BP compared to White women (all p<0.0001). Hispanic women had higher rates of diabetes (p=0.009) and no place to go for healthcare (p=0.005) compared to White women. Food insecurity was present in 34% of Hispanic women. Conclusions: Despite effective diagnostics and therapy, health inequity is common in women of child-bearing age with HTN, with differences by race/ethnicity in social determinants and co-morbid conditions. Each racial/ethnic group with HTN brings social determinants and comorbid conditions important for providers to recognize.

scholarly journals Racial and Ethnic Disparities in Maternal Outcomes and the Disadvantage of Peripartum Black Women: A Multistate Analysis, 2007–2014

2018 ◽  
Vol 36 (08) ◽  
pp. 835-848 ◽  
Author(s):  
Virginia Tangel ◽  
Robert S. White ◽  
Anna S. Nachamie ◽  
Jeremy S. Pick
Keyword(s):  
Black Women ◽  
Length Of Stay ◽  
Cesarean Delivery ◽  
White Women ◽  
Average Length ◽  
Ethnic Disparities ◽  
Maternal Outcomes ◽  
Racial And Ethnic Disparities ◽  
Mortality And Morbidity ◽  
Race Ethnicity

Objective Racial and ethnic disparities in obstetric care and delivery outcomes have shown that black women experience high rates of pregnancy-related mortality and morbidity, along with high rates of cesarean delivery, compared with other racial and ethnic groups. We aimed to quantify these disparities and test the effects of race/ethnicity in stratified statistical models by insurance payer and socioeconomic status, adjusting for comorbidities specific to an obstetric population. Study Design We analyzed maternal outcomes in a sample of 6,872,588 delivery records from California, Florida, Kentucky, Maryland, and New York from 2007 to 2014 from the State Inpatient Databases, Healthcare Cost and Utilization Project. We compared present-on-admission characteristics of parturients by race/ethnicity, and estimated logistic regression and generalized linear models to assess outcomes of in-hospital mortality, cesarean delivery, and length of stay. Results Compared with white women, black women were more likely to die in-hospital (odds ratio [OR]: 1.90, 95% confidence interval [CI]: 1.47–2.45) and have a longer average length of stay (incidence rate ratio: 1.10, 95% CI: 1.09–1.10). Black women also were more likely to have a cesarean delivery (OR: 1.12, 95% CI 1.12–1.13) than white women. These results largely held in stratified analyses. Conclusion In most insurance payers and socioeconomic strata, race/ethnicity alone is a factor that predicts parturient outcomes.

scholarly journals New onset of restless legs syndrome in pregnancy in a prospective multiracial cohort

Neurology ◽  
2020 ◽  
Vol 95 (24) ◽  
pp. e3438-e3447
Author(s):  
Muzi Na ◽  
Jing Wu ◽  
Mengying Li ◽  
Stefanie N. Hinkle ◽  
Cuilin Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Black Women ◽  
Restless Legs Syndrome ◽  
White Women ◽  
Hispanic Women ◽  
Nutritional Factors ◽  
Restless Legs ◽  
Relative Risks ◽  
Race Ethnicity ◽  
In Pregnancy

ObjectiveTo determine whether the incidence and risk factors of restless legs syndrome (RLS) in pregnancy differ by race/ethnicity, we estimated relative risks of demographic, socioeconomic, and nutritional factors in association with risk of any incident RLS in pregnancy in a cohort of 2,704 healthy pregnant women without prior RLS.MethodsUsing data from the multicenter, multiracial National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies–Singletons, we examined the incidence of RLS from early pregnancy to near delivery through up to 6 assessments. Multivariable Poisson models with robust variance were applied to estimate relative risks (RRs).ResultsThe cumulative incidence of RLS in pregnancy was 18.1% for all women, 20.3% for White women, 15.4% for Black women, 17.1% for Hispanic women, and 21.1% for Asian women. Among Hispanic women, older age (RR [reference ≤25 years]: 25–35 years, 1.51; 95% confidence interval [CI] 1.05–2.16; ≥35 years, 1.58; 95% CI 0.93–2.68), anemia (RR [reference no]: yes, 2.47; 95% CI 1.31–4.64), and greater total skinfolds of the subscapular and triceps sites, independent of body mass index (RR [reference quartile 1]: quartile 5, 2.54; 95% CI 1.30–4.97; p trend = 0.01) were associated with higher risk of RLS, while multiparity was associated with a lower risk (RR [reference nulliparity]: 0.69; 95% CI 0.50–0.96). In Black women, greater skinfolds and waist circumference were associated with higher risk of pregnancy RLS, although the trends were less clear.ConclusionsThe incidence of RLS in pregnancy was high and differed by race/ethnicity, which is likely accounted for by differences in other risk factors, such as age, parity, and nutritional factors.

Disparities at the Intersection of Race and Ethnicity: Examining Trends and Outcomes in Hispanic Women With Breast Cancer

2020 ◽  
pp. OP.20.00381
Author(s):  
Cosette D. Champion ◽  
Samantha M. Thomas ◽  
Jennifer K. Plichta ◽  
Edgardo Parrilla Castellar ◽  
Laura H. Rosenberger ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
Racial Differences ◽  
White Women ◽  
Hispanic Women ◽  
Hazard Ratio ◽  
Tumor Subtype ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
Hispanic White

PURPOSE: We sought to examine tumor subtype, stage at diagnosis, time to surgery (TTS), and overall survival (OS) among Hispanic patients of different races and among Hispanic and non-Hispanic (NH) women of the same race. METHODS: Women 18 years of age or older who had been diagnosed with stage 0-IV breast cancer and who had undergone lumpectomy or mastectomy were identified in the National Cancer Database (2004-2014). Tumor subtype and stage at diagnosis were compared by race/ethnicity. Multivariable linear regression and Cox proportional hazards modeling were used to estimate associations between race/ethnicity and adjusted TTS and OS, respectively. RESULTS: A total of 44,374 Hispanic (American Indian [AI]: 79 [0.2%]; Black: 1,011 [2.3%]; White: 41,126 [92.7%]; Other: 2,158 [4.9%]) and 858,634 NH women (AI: 2,319 [0.3%]; Black: 97,206 [11.3%]; White: 727,270 [84.7%]; Other: 31,839 [3.7%]) were included. Hispanic Black women had lower rates of triple-negative disease (16.2%) than did NH Black women (23.5%) but higher rates than did Hispanic White women (13.9%; P < .001). Hispanic White women had higher rates of node-positive disease (23.2%) versus NH White women (14.4%) but slightly lower rates than Hispanic (24.6%) and NH Black women (24.5%; P < .001). Hispanic White women had longer TTS versus NH White women regardless of treatment sequence (adjusted means: adjuvant chemotherapy, 42.71 v 38.60 days; neoadjuvant chemotherapy, 208.55 v 201.14 days; both P < .001), but there were no significant racial differences in TTS among Hispanic patients. After adjustment, Hispanic White women (hazard ratio, 0.77 [95% CI, 0.74 to 0.81]) and Black women (hazard ratio, 0.75 [95% CI, 0.58 to 0.96]) had improved OS versus NH White women (reference) and Black women (hazard ratio, 1.15 [95% CI, 1.12 to 1.18]; all P < .05). CONCLUSION: Hispanic women had improved OS versus NH women, but racial differences in tumor subtype and nodal stage among Hispanic women highlight the importance of disaggregating racial/ethnic data in breast cancer research.

scholarly journals Racial and Ethnic Disparities in Maternal and Infant Outcomes Among Opioid-Exposed Mother–Infant Dyads in Massachusetts (2017–2019)

2020 ◽  
Vol 110 (12) ◽  
pp. 1828-1836
Author(s):  
Mary Peeler ◽  
Munish Gupta ◽  
Patrice Melvin ◽  
Allison S. Bryant ◽  
Hafsatou Diop ◽  
...  
Keyword(s):  
Black Women ◽  
White Women ◽  
Hispanic Women ◽  
Ethnic Disparities ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Infant Outcomes ◽  
Race Ethnicity ◽  
Hispanic White ◽  
Maternal Race

Objectives. To examine the extent to which differences in medication for opioid use disorder (MOUD) in pregnancy and infant neonatal opioid withdrawal syndrome (NOWS) outcomes are associated with maternal race/ethnicity. Methods. We performed a secondary analysis of a statewide quality improvement database of opioid-exposed deliveries from January 2017 to April 2019 from 24 hospitals in Massachusetts. We used multivariable mixed-effects logistic regression to model the association between maternal race/ethnicity (non-Hispanic White, non-Hispanic Black, or Hispanic) and prenatal receipt of MOUD, NOWS severity, early intervention referral, and biological parental custody at discharge. Results. Among 1710 deliveries to women with opioid use disorder, 89.3% (n = 1527) were non-Hispanic White. In adjusted models, non-Hispanic Black women (AOR = 0.34; 95% confidence interval [CI] = 0.18, 0.66) and Hispanic women (AOR = 0.43; 95% CI = 0.27, 0.68) were less likely to receive MOUD during pregnancy compared with non-Hispanic White women. We found no statistically significant associations between maternal race/ethnicity and infant outcomes. Conclusions. We identified significant racial/ethnic differences in MOUD prenatal receipt that persisted in adjusted models. Research should focus on the perspectives and treatment experiences of non-Hispanic Black and Hispanic women to ensure equitable care for all mother–infant dyads.

Race-Ethnicity and Medical Services for Infertility

2011 ◽  
Vol 52 (4) ◽  
pp. 493-509 ◽  
Author(s):  
Arthur L. Greil ◽  
Julia McQuillan ◽  
Karina M. Shreffler ◽  
Katherine M. Johnson ◽  
Kathleen S. Slauson-Blevins
Keyword(s):  
Women Of Color ◽  
White Women ◽  
Hispanic Women ◽  
Private Insurance ◽  
The United States ◽  
Medical Services ◽  
Reproductive Control ◽  
Stratified Reproduction ◽  
Race Ethnicity ◽  
Levels Of Service

Evidence of group differences in reproductive control and access to reproductive health care suggests the continued existence of “stratified reproduction” in the United States. Women of color are overrepresented among people with infertility but are underrepresented among those who receive medical services. The authors employ path analysis to uncover mechanisms accounting for these differences among black, Hispanic, Asian, and non-Hispanic white women using a probability-based sample of 2,162 U.S. women. Black and Hispanic women are less likely to receive services than other women. The enabling conditions of income, education, and private insurance partially mediate the relationship between race-ethnicity and receipt of services but do not fully account for the association at all levels of service. For black and Hispanic women, social cues, enabling conditions, and predisposing conditions contribute to disparities in receipt of services. Most of the association between race-ethnicity and service receipt is indirect rather than direct.

scholarly journals Variation in Attitudes toward Being a Mother by Race/Ethnicity and Education among Women in the United States

2016 ◽  
Vol 60 (3) ◽  
pp. 600-619 ◽  
Author(s):  
Veronica Tichenor ◽  
Julia McQuillan ◽  
Arthur L. Greil ◽  
Andrew V. Bedrous ◽  
Amy Clark ◽  
...  
Keyword(s):  
Black Women ◽  
White Women ◽  
Hispanic Women ◽  
The United States ◽  
Relationship Type ◽  
Raising Children ◽  
Number Of Children ◽  
Positive Attitudes ◽  
Race Ethnicity ◽  
Attitudes Toward Motherhood

Do differences in experiences of motherhood (e.g., number of children, age at first child, and relationship type) by race/ethnicity and social class mean that attitudes toward motherhood also vary by social location? We examine attitudes toward being a mother among black, Hispanic, Asian, and white women of higher and lower socioeconomic status (SES, as measured by education). Results using the National Survey of Fertility Barriers ( N = 4,796) indicate that, despite fertility differences, attitudes toward being a mother differ little between groups. White and Asian women have higher positive attitudes toward being a mother than black and Hispanic women. Only black women appear to distinguish between having and raising children; surprisingly, lower educated Hispanic women are less likely to think that they would be a mother, see motherhood as fulfilling, and think that it is important to have and to raise children compared with higher educated, white women.

scholarly journals To What Extent Is the Association Between Race/Ethnicity and Fetal Growth Restriction Explained by Adequacy of Prenatal Care? A Mediation Analysis of a Retrospectively Selected Cohort

2020 ◽  
Vol 189 (11) ◽  
pp. 1360-1368
Author(s):  
Khalidha Nasiri ◽  
Erica E M Moodie ◽  
Haim A Abenhaim
Keyword(s):  
Black Women ◽  
Prenatal Care ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
White Women ◽  
Hispanic Women ◽  
Excess Risk ◽  
Growth Restriction ◽  
Adequacy Of Prenatal Care ◽  
Race Ethnicity

Abstract Race/ethnicity is associated with intrauterine growth restriction (IUGR) and small-for-gestational age (SGA) birth. We evaluated the extent to which this association is mediated by adequacy of prenatal care (PNC). A retrospective cohort study was conducted using US National Center for Health Statistics natality files for the years 2011–2017. We performed mediation analyses using a statistical approach that allows for exposure-mediator interaction, and we estimated natural direct effects, natural indirect effects, and proportions mediated. All effects were estimated as risk ratios. Among 23,118,656 singleton live births, the excess risk of IUGR among Black women, Hispanic women, and women of other race/ethnicity as compared with White women was partly mediated by PNC adequacy: 13% of the association between non-Hispanic Black race/ethnicity and IUGR, 12% of the association in Hispanic women, and 10% in other women was attributable to PNC inadequacy. The percentage of excess risk of SGA birth that was mediated was 7% in Black women, 6% in Hispanic women, and 5% in other women. Our findings suggest that PNC adequacy may partly mediate the association between race/ethnicity and fetal growth restriction. In future research, investigators should employ causal mediation frameworks to consider additional factors and mediators that could help us better understand this association.

Neighborhood Privilege, Preterm Delivery, and Related Racial/Ethnic Disparities: An Intergenerational Application of the Index of Concentration at the Extremes

2020 ◽  
Vol 189 (5) ◽  
pp. 412-421 ◽  
Author(s):  
Bina Patel Shrimali ◽  
Michelle Pearl ◽  
Deborah Karasek ◽  
Carolina Reid ◽  
Barbara Abrams ◽  
...  
Keyword(s):  
Early Childhood ◽  
Black Women ◽  
Preterm Delivery ◽  
White Women ◽  
Hispanic Women ◽  
Ethnic Disparities ◽  
Estimating Equation ◽  
Individual Level ◽  
Race Ethnicity ◽  
Racial Ethnic

Abstract We assessed whether early childhood and adulthood experiences of neighborhood privilege, measured by the Index of Concentration at the Extremes (ICE), were associated with preterm delivery and related racial/ethnic disparities using intergenerationally linked birth records of 379,794 California-born primiparous mothers (born 1982–1997) and their infants (born 1997–2011). ICE measures during early childhood and adulthood approximated racial/ethnic and economic dimensions of neighborhood privilege and disadvantage separately (ICE-income, ICE-race/ethnicity) and in combination (ICE–income + race/ethnicity). Results of our generalized estimating equation models with robust standard errors showed associations for ICE-income and ICE–income + race/ethnicity. For example, ICE–income + race/ethnicity was associated with preterm delivery in both early childhood (relative risk (RR) = 1.12, 95% confidence interval (CI): 1.08, 1.17) and adulthood (RR = 1.07, 95% CI: 1.03, 1.11). Non-Hispanic black and Hispanic women had higher risk of preterm delivery than white women (RR = 1.32, 95% CI: 1.28, 1.37; and RR = 1.11, 95% CI: 1.08, 1.14, respectively, adjusting for individual-level confounders). Adjustment for ICE–income + race/ethnicity at both time periods yielded the greatest declines in disparities (for non-Hispanic black women, RR = 1.23, 95% CI: 1.18, 1.28; for Hispanic women, RR = 1.05, 95% CI: 1.02, 1.09). Findings support independent effects of early childhood and adulthood neighborhood privilege on preterm delivery and related disparities.

Discordance Between Perinatal Alcohol Use Among Women and Provider Counseling for Alcohol Use: An Assessment of the Pregnancy Risk Assessment Monitoring System

2021 ◽  
pp. 003335492098414
Author(s):  
Erika L. Thompson ◽  
Tracey E. Barnett ◽  
Dana M. Litt ◽  
Erica C. Spears ◽  
Melissa A. Lewis
Keyword(s):  
Black Women ◽  
Alcohol Use ◽  
Universal Screening ◽  
White Women ◽  
Hispanic Women ◽  
Pregnancy Risk ◽  
Health Insurance Status ◽  
Prenatal Alcohol Use ◽  
Prenatal Alcohol ◽  
Alcohol Counseling

Objective In the United States, guidelines indicate all pregnant women should be screened for and counseled on alcohol use to prevent adverse perinatal outcomes due to alcohol consumption. The objective of this study was to describe sociodemographic factors associated with receipt of prenatal alcohol counseling and perinatal alcohol use among US women. Methods State health departments collected data for the Pregnancy Risk Assessment Monitoring System Phase 7 during 2012-2015, and we restricted the sample to a complete case analysis (N = 135 111). The 3 dichotomous outcomes were preconception alcohol use (3 months before pregnancy), prenatal alcohol use (during last 3 months of pregnancy), and prenatal alcohol counseling. Predictor variables were age, race, Hispanic ethnicity, education, marital status, health insurance status, and previous live births. We estimated survey-weighted logistic regression models for each outcome. Results Half (56.0%) of pregnant women reported preconception alcohol use, 70.5% received prenatal alcohol counseling, and 7.7% reported prenatal alcohol use during the last 3 months of pregnancy. Black women were significantly less likely than White women (odds ratio [OR] = 0.49; 95% CI, 0.46-0.52) and Hispanic women were significantly less likely than non-Hispanic women (OR = 0.62; 95% CI, 0.58-0.66) to report preconception alcohol use. We found similar patterns for prenatal alcohol use among Black women. Black women were significantly more likely than White women (OR = 1.66; 95% CI, 1.55-1.77) and Hispanic women were significantly more likely than non-Hispanic women (OR = 1.51; 95% CI, 1.40-1.61) to receive prenatal alcohol counseling. We found similar patterns for age, education, and health insurance status. Conclusion Disparities in alcohol counseling occurred despite the national recommendation for universal screening and counseling prenatally. Continued integration of universal screening for alcohol use during pregnancy is needed.

Racial and Ethnic Disparities in Peripartum Hysterectomy Risk and Outcomes

2021 ◽  
Author(s):  
Margaret H. Bogardus ◽  
Timothy Wen ◽  
Cynthia Gyamfi-Bannerman ◽  
Jason D. Wright ◽  
Dena Goffman ◽  
...  
Keyword(s):  
Black Women ◽  
Race And Ethnicity ◽  
White Women ◽  
Hispanic Women ◽  
Intraoperative Complications ◽  
Ethnic Disparities ◽  
Peripartum Hysterectomy ◽  
Increased Risk ◽  
Surgical Site Complications ◽  
Hispanic White

Objective This study aimed to determine whether race and ethnicity contribute to risks associated with peripartum hysterectomy. Study Design This retrospective cross-sectional study utilized the 2000–2014 Nationwide Inpatient Sample to analyze risk of peripartum hysterectomy and associated severe maternal morbidity, mortality, surgical injury, reoperation, surgical-site complications, and mortality by maternal race and ethnicity. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, other, and unknown. Multivariable log-linear regression models including patient, clinical, and hospital risk factors were performed with adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). Results Of 59,854,731 delivery hospitalizations, there were 45,369 peripartum hysterectomies (7.6 per thousand). Of these, 37.8% occurred among non-Hispanic white, 13.9% among non-Hispanic black, and 22.8% among Hispanic women. In adjusted analyses, non-Hispanic black (aRR: 1.21, 95% CI: 1.17–1.29) and Hispanic women (aRR: 1.25, 95% CI: 1.22–1.29) were at increased risk of hysterectomy compared with non-Hispanic white women. Risk for severe morbidity was increased for non-Hispanic black (aRR: 1.25, 95% CI: 1.19–1.33), but not for Hispanic (aRR: 1.02, 95% CI: 0.97–1.07) women. Between these three groups, risk for intraoperative complications was highest among non-Hispanic white women, risk for reoperation was highest among Hispanic women, and risk for surgical-site complications was highest among non-Hispanic black women. Evaluating maternal mortality, non-Hispanic black women (RR: 3.83, 95% CI: 2.65–5.53) and Hispanic women (RR: 2.49, 95% CI: 1.74–3.59) were at higher risk than non-Hispanic white women. Conclusion Peripartum hysterectomy and related complications other than death differed modestly by race. In comparison, mortality differentials were large supporting that differential risk for death in the setting of this high-risk scenario may be an important cause of disparities. Key Points

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