(137) Neighborhood deprivation in Rhode Island and chronic hypertension during high-risk pregnancy

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: Chronic hypertension (cHTN) is a leading cause of adverse perinatal outcomes, and neighborhood factors have been associated with higher rates of cHTN. Given >80% of deliveries occur at a single hospital, Rhode Island is an ideal state to explore the association between neighborhood deprivation and gestational age at delivery for pregnancies complicated by cHTN.

Study Design: This is a secondary analysis of a large NIH-funded retrospective cohort of 11,137 high-risk patients with singleton pregnancies delivering from January 2002 to March 2013. State specific area deprivation index (ADI) scores were linked to individual patient address at time of delivery among pregnancies complicated by cHTN. ADI scores were stratified into tertiles (least, average, and most deprived neighborhoods) based on the distribution of ADI in Rhode Island. Linear regression for mean difference in maximum systolic and diastolic blood pressure at time of diagnosis and Cox proportional hazards regression for the hazard of gestational age at delivery were performed with adjustments for confounders.

Results:

Of the 1,427 patients in the parent study with cHTN, 231 (16.2%) resided in the least deprived, 363 (25.4%) average, and 833 (58.4%) in the most deprived neighborhood. After adjusting for confounders, there were no associations between neighborhood deprivation and cHTN prevalence. Maximum systolic and diastolic blood pressures at time of diagnosis were not significantly different by neighborhood deprivation. There were no statistically significant differences in gestational age at delivery between neighborhoods.

Conclusion: Within a cohort of high-risk pregnant patients in Rhode Island, state-specific neighborhood deprivation was not independently associated with increased rates of cHTN or maximum blood pressure values at cHTN diagnosis or gestational age at delivery. Yet, social determinants of health do not exist in isolation, and the higher proportion of those with cHTN residing in most high-needs neighborhoods suggest targeting these areas may improve perinatal outcomes.

Primary & Presenting Author(s)

Brock Polnaszek, MD
Maternal Fetal Medicine Fellow
Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States

Coauthor(s)

Lauren Murphy, MD
Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
CR
Christina Raker, DSc
Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
VD
Valery A. Danilack, PhD,MPH
Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
DS
David A. Savitz, PhD
Department of Epidemiology, Brown University School of Public Health
Providence, Rhode Island, United States
Methodius G. Tuuli, MD, MPH, MBA
Chace-Joukowsky Professor and Chair
Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
East Greenwich, Rhode Island, United States
Emily S. Miller, MD, MPH (she/her/hers)
Director, Division of Maternal-Fetal Medicine
Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island
Providence, Rhode Island, United States
Adam K. Lewkowitz, MD, MPHS
Assistant Professor
Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island
Providence, Rhode Island, United States