Pre-Pregnancy Hypertension Among Women in Rural and Urban Areas of the United States

Rates of maternal mortality are increasing in the United States with significant rural-urban disparities. Pre-pregnancy hypertension is a well-established risk factor for adverse maternal and offspring outcomes. The purpose of this study was to describe trends in maternal pre-pregnancy hypertension...

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Veröffentlicht in:Journal of the American College of Cardiology 2020-12, Vol.76 (22), p.2611-2619
Hauptverfasser: Cameron, Natalie A., Molsberry, Rebecca, Pierce, Jacob B., Perak, Amanda M., Grobman, William A., Allen, Norrina B., Greenland, Philip, Lloyd-Jones, Donald M., Khan, Sadiya S.
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container_issue 22
container_start_page 2611
container_title Journal of the American College of Cardiology
container_volume 76
creator Cameron, Natalie A.
Molsberry, Rebecca
Pierce, Jacob B.
Perak, Amanda M.
Grobman, William A.
Allen, Norrina B.
Greenland, Philip
Lloyd-Jones, Donald M.
Khan, Sadiya S.
description Rates of maternal mortality are increasing in the United States with significant rural-urban disparities. Pre-pregnancy hypertension is a well-established risk factor for adverse maternal and offspring outcomes. The purpose of this study was to describe trends in maternal pre-pregnancy hypertension among women in rural and urban areas in 2007 to 2018 in order to inform community-engaged prevention and policy strategies. We performed a nationwide, serial cross-sectional study using maternal data from all live births in women age 15 to 44 years between 2007 and 2018 (CDC Natality Database). Rates of pre-pregnancy hypertension were calculated per 1,000 live births overall and by urbanization status. Subgroup analysis in standard 5-year age categories was performed. We quantified average annual percentage change using Joinpoint Regression and rate ratios (95% confidence intervals [CIs]) to compare yearly rates between rural and urban areas. Among 47,949,381 live births to women between 2007 and 2018, rates of pre-pregnancy hypertension per 1,000 live births increased among both rural (13.7 to 23.7) and urban women (10.5 to 20.0). Two significant inflection points were identified in 2010 and 2016, with highest annual percentage changes between 2016 and 2018 in rural and urban areas. Although absolute rates were lower in younger compared with older women in both rural and urban areas, all age groups experienced similar increases. The rate ratios of pre-pregnancy hypertension in rural compared with urban women ranged from 1.18 (95% CI: 1.04 to 1.35) for ages 15 to 19 years to 1.51 (95% CI: 1.39 to 1.64) for ages 40 to 44 years in 2018. Maternal burden of pre-pregnancy hypertension has nearly doubled in the past decade and the rural-urban gap has persisted. [Display omitted]
doi_str_mv 10.1016/j.jacc.2020.09.601
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Pre-pregnancy hypertension is a well-established risk factor for adverse maternal and offspring outcomes. The purpose of this study was to describe trends in maternal pre-pregnancy hypertension among women in rural and urban areas in 2007 to 2018 in order to inform community-engaged prevention and policy strategies. We performed a nationwide, serial cross-sectional study using maternal data from all live births in women age 15 to 44 years between 2007 and 2018 (CDC Natality Database). Rates of pre-pregnancy hypertension were calculated per 1,000 live births overall and by urbanization status. Subgroup analysis in standard 5-year age categories was performed. We quantified average annual percentage change using Joinpoint Regression and rate ratios (95% confidence intervals [CIs]) to compare yearly rates between rural and urban areas. Among 47,949,381 live births to women between 2007 and 2018, rates of pre-pregnancy hypertension per 1,000 live births increased among both rural (13.7 to 23.7) and urban women (10.5 to 20.0). Two significant inflection points were identified in 2010 and 2016, with highest annual percentage changes between 2016 and 2018 in rural and urban areas. Although absolute rates were lower in younger compared with older women in both rural and urban areas, all age groups experienced similar increases. The rate ratios of pre-pregnancy hypertension in rural compared with urban women ranged from 1.18 (95% CI: 1.04 to 1.35) for ages 15 to 19 years to 1.51 (95% CI: 1.39 to 1.64) for ages 40 to 44 years in 2018. Maternal burden of pre-pregnancy hypertension has nearly doubled in the past decade and the rural-urban gap has persisted. 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source MEDLINE; Access via ScienceDirect (Elsevier); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection
subjects Adolescent
Adult
Cross-Sectional Studies
disparities
Ethnicity
Female
Health Services Needs and Demand
Healthcare Disparities - statistics & numerical data
Humans
hypertension
Hypertension - diagnosis
Hypertension - epidemiology
maternal morbidity
Maternal Mortality - trends
Pregnancy
Pregnancy Complications, Cardiovascular - diagnosis
Pregnancy Complications, Cardiovascular - epidemiology
race/ethnicity
Risk Assessment - methods
Risk Assessment - statistics & numerical data
Risk Factors
rural
Rural Health - statistics & numerical data
United States - epidemiology
Urban Health - statistics & numerical data
title Pre-Pregnancy Hypertension Among Women in Rural and Urban Areas of the United States
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