(902) The Inequity of Eclampsia in Southern California

Preeclampsia rates are rising in the United States and racial/ethnic disparities for this disorder are well described. The subtle presenting symptoms of preeclampsia (PEC) make early diagnosis difficult without effective resources. The Social Vulnerability Index (SVI) leverages census data to identify vulnerable communities. We sought to describe rates of PEC and eclampsia (EC) by SVI. We hypothesized that PEC and EC would be more common by increased SVI but that SVI distribution would be similar between PEC and EC. 

Study Design:

Leveraging electronic medical record data from a single institution with a large catchment area in Southern California, we performed a cross sectional analysis of preeclampsia and eclampsia by social vulnerability quartile. The CDC SVI score* uses 15 US Census variables to identify vulnerable communities by a combined score of socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. Higher scores indicate greater social vulnerability.  Our analysis defined SVI score by linking patient’s zip code to this census tract information.  The quartile of SVI score was compared in 3 groups: 1) pregnant people without a hypertensive disorder (PWH), 2) those diagnosed with PEC without EC, and 3) those with EC delivering from January 2013 to July 2022.  Chi-Square analyses were used to compare frequencies. 

Results:

Of the PWH (N=74,372), 41.0% reside in the most socially vulnerable quartile (Table 1, Figure 1). Compared with those PWH, 47.4% of those with PEC (p < 0.0001) and 53.6% of those with EC live in areas that are most socially vulnerable (p < 0.0001). The quartile distribution of EC patients was significantly more skewed towards social vulnerability as compared with PEC (p=0.0058).

Conclusion:

Contrary to our hypothesis, the most socially vulnerable quartile had more patients with eclampsia than preeclampsia, but both EC and PEC were more common here than pregnancies without hypertension. Further studies are required to understand if this may be due to barriers in accessing medical care.