Introduction: The hypertensive disorders of pregnancy (HDP) are associated with increased CVD risk in women. The prevalence of both HDP and CVD vary with race/ethnicity. We examined racial/ethnic differences in CVD outcomes amongst women with these disorders in the California Healthcare Cost and Utilization Project State Inpatient Database (CA HCUP-SID).
Methods: Women in the CA HCUP-SID who gave birth between 2005 and 2009 were classified by self-reported race/ethnicity (white, black, Hispanic/Latina, Asian/Pacific Islander, other). We employed Cox proportional hazards regression analyses in multivariable-adjusted models to determine the association of HDP subtypes (gestational HTN, preeclampsia, chronic HTN, chronic HTN plus preeclampsia, or normal pregnancy as the reference group) with time to hospitalization for HF and MI through 2011 among race/ethnic groups. We then tested for effect modification of race/ethnicity on HF and MI hospitalizations.
Results: The 1,565,866 women in the CA HCUP-SID who gave birth between 2005 and 2009 had an average age of 28.5 ± 6.2 years and a mean follow-up period of 4.7 ± 1.4 years. Of these women, 39.8% were white, 6.5% were black, 38.9% were Hispanic/Latina, and 12.1% were Asian/Pacific Islander. All HDP subtypes were significantly associated with HF, and the effect modification of race/ethnicity on incident HF hospitalization was significant (p=0.02) (Figure1). HDP was also significantly associated with future MI. Hazard ratios for MI ranged from 2.7 (95% CI: 2.1 - 3.7) for gestational HTN to 6.0 (95% CI: 4.13 - 8.81) for chronic HTN; effect modification by race/ethnicity was not significant for MI (p=0.78).
Conclusion: Our analysis demonstrated increased hazards for HF hospitalization across all HDP subtypes that were significantly modified by race/ethnicity. Black women with these disorders had lower HF hazards compared to all other women, while Asian/Pacific Islanders had higher HF hazards compared to white women.