Association of Race and Ethnicity and Social Factors With Postpartum Primary Care or Cardiology Follow‐Up Visits Among Individuals With Preeclampsia
Background Preeclampsia is associated with increased cardiovascular morbidity and death. Primary care or cardiology follow‐up, in complement to routine postpartum obstetric care, provides an essential opportunity to address cardiovascular risk. Prior studies investigating racial differences in the r...
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| Format: | Article |
| Language: | English |
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Wiley
2024-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.033188 |
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| author | Malamo E. Countouris Kayle S. Shapero Gretchen Swabe Alisse Hauspurg Esa M. Davis Jared W. Magnani |
| author_facet | Malamo E. Countouris Kayle S. Shapero Gretchen Swabe Alisse Hauspurg Esa M. Davis Jared W. Magnani |
| author_sort | Malamo E. Countouris |
| collection | DOAJ |
| description | Background Preeclampsia is associated with increased cardiovascular morbidity and death. Primary care or cardiology follow‐up, in complement to routine postpartum obstetric care, provides an essential opportunity to address cardiovascular risk. Prior studies investigating racial differences in the recommended postpartum follow‐up have incompletely assessed the influence of social factors. We hypothesized that racial and ethnic differences in follow‐up with a primary care provider or cardiologist would be modified by income and education. Methods and Results We identified adult individuals with preeclampsia (September 2014 to September 2019) in a national administrative database. We compared occurrence of a postpartum visit with a primary care provider or cardiologist within 1 year after delivery by race and ethnicity using multivariable logistic regression models. We examined whether education or income modified the association between race and ethnicity and the likelihood of follow‐up. Of 18 050 individuals with preeclampsia (aged 31.8±5.7 years), Black individuals (11.7%) had lower odds of primary care provider or cardiology follow‐up within 1 year after delivery compared with White individuals (adjusted odds ratio, 0.77 [95% CI, 0.70–0.85]) as did Hispanic individuals (14.8%; adjusted odds ratio, 0.79 [95% CI, 0.73–0.87]). Black and Hispanic individuals with higher educational attainment were more likely to have follow‐up than those with lower educational attainment (P for interaction=0.033) as did those in higher income brackets (P for interaction=0.006). Conclusions We identified racial and ethnic differences in primary care or cardiology follow‐up in the year postpartum among individuals diagnosed with preeclampsia, a disparity that may be modified by social factors. Enhanced system‐level interventions are needed to reduce barriers to follow‐up care. |
| format | Article |
| id | doaj-art-a61bc6289996450eae862df68bc767e9 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-a61bc6289996450eae862df68bc767e92024-11-28T09:27:28ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-08-01131610.1161/JAHA.123.033188Association of Race and Ethnicity and Social Factors With Postpartum Primary Care or Cardiology Follow‐Up Visits Among Individuals With PreeclampsiaMalamo E. Countouris0Kayle S. Shapero1Gretchen Swabe2Alisse Hauspurg3Esa M. Davis4Jared W. Magnani5Division of Cardiology, Department of Medicine University of Pittsburgh Medical Center Pittsburgh PA USALifespan Cardiovascular Institute, Warren Alpert Medical School of Brown University Providence RI USADivision of Cardiology, Department of Medicine University of Pittsburgh Medical Center Pittsburgh PA USADepartment of Obstetrics, Gynecology, and Reproductive Sciences University of Pittsburgh Pittsburgh PA USADepartment of Family and Community Medicine University of Maryland Baltimore MD USADivision of Cardiology, Department of Medicine University of Pittsburgh Medical Center Pittsburgh PA USABackground Preeclampsia is associated with increased cardiovascular morbidity and death. Primary care or cardiology follow‐up, in complement to routine postpartum obstetric care, provides an essential opportunity to address cardiovascular risk. Prior studies investigating racial differences in the recommended postpartum follow‐up have incompletely assessed the influence of social factors. We hypothesized that racial and ethnic differences in follow‐up with a primary care provider or cardiologist would be modified by income and education. Methods and Results We identified adult individuals with preeclampsia (September 2014 to September 2019) in a national administrative database. We compared occurrence of a postpartum visit with a primary care provider or cardiologist within 1 year after delivery by race and ethnicity using multivariable logistic regression models. We examined whether education or income modified the association between race and ethnicity and the likelihood of follow‐up. Of 18 050 individuals with preeclampsia (aged 31.8±5.7 years), Black individuals (11.7%) had lower odds of primary care provider or cardiology follow‐up within 1 year after delivery compared with White individuals (adjusted odds ratio, 0.77 [95% CI, 0.70–0.85]) as did Hispanic individuals (14.8%; adjusted odds ratio, 0.79 [95% CI, 0.73–0.87]). Black and Hispanic individuals with higher educational attainment were more likely to have follow‐up than those with lower educational attainment (P for interaction=0.033) as did those in higher income brackets (P for interaction=0.006). Conclusions We identified racial and ethnic differences in primary care or cardiology follow‐up in the year postpartum among individuals diagnosed with preeclampsia, a disparity that may be modified by social factors. Enhanced system‐level interventions are needed to reduce barriers to follow‐up care.https://www.ahajournals.org/doi/10.1161/JAHA.123.033188follow‐uphypertensive disorders of pregnancypreeclampsiaprimary careracial disparities |
| spellingShingle | Malamo E. Countouris Kayle S. Shapero Gretchen Swabe Alisse Hauspurg Esa M. Davis Jared W. Magnani Association of Race and Ethnicity and Social Factors With Postpartum Primary Care or Cardiology Follow‐Up Visits Among Individuals With Preeclampsia Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease follow‐up hypertensive disorders of pregnancy preeclampsia primary care racial disparities |
| title | Association of Race and Ethnicity and Social Factors With Postpartum Primary Care or Cardiology Follow‐Up Visits Among Individuals With Preeclampsia |
| title_full | Association of Race and Ethnicity and Social Factors With Postpartum Primary Care or Cardiology Follow‐Up Visits Among Individuals With Preeclampsia |
| title_fullStr | Association of Race and Ethnicity and Social Factors With Postpartum Primary Care or Cardiology Follow‐Up Visits Among Individuals With Preeclampsia |
| title_full_unstemmed | Association of Race and Ethnicity and Social Factors With Postpartum Primary Care or Cardiology Follow‐Up Visits Among Individuals With Preeclampsia |
| title_short | Association of Race and Ethnicity and Social Factors With Postpartum Primary Care or Cardiology Follow‐Up Visits Among Individuals With Preeclampsia |
| title_sort | association of race and ethnicity and social factors with postpartum primary care or cardiology follow up visits among individuals with preeclampsia |
| topic | follow‐up hypertensive disorders of pregnancy preeclampsia primary care racial disparities |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.033188 |
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