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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Published in | Journal of the American College of Cardiology Vol. 76; no. 22; pp. 2611 - 2619 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
Elsevier Inc
01.12.2020
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Abstract | 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.
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AbstractList | 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] 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. |
Author | Molsberry, Rebecca Lloyd-Jones, Donald M. Allen, Norrina B. Greenland, Philip Grobman, William A. Cameron, Natalie A. Perak, Amanda M. Pierce, Jacob B. Khan, Sadiya S. |
AuthorAffiliation | b Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Dallas, Texas c Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois a Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois e Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois d Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois f Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois |
AuthorAffiliation_xml | – name: f Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois – name: c Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois – name: e Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois – name: b Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Dallas, Texas – name: d Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois – name: a Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois |
Author_xml | – sequence: 1 givenname: Natalie A. surname: Cameron fullname: Cameron, Natalie A. organization: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois – sequence: 2 givenname: Rebecca surname: Molsberry fullname: Molsberry, Rebecca organization: Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Dallas, Texas – sequence: 3 givenname: Jacob B. surname: Pierce fullname: Pierce, Jacob B. organization: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois – sequence: 4 givenname: Amanda M. surname: Perak fullname: Perak, Amanda M. organization: Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois – sequence: 5 givenname: William A. surname: Grobman fullname: Grobman, William A. organization: Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois – sequence: 6 givenname: Norrina B. surname: Allen fullname: Allen, Norrina B. organization: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois – sequence: 7 givenname: Philip surname: Greenland fullname: Greenland, Philip organization: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois – sequence: 8 givenname: Donald M. surname: Lloyd-Jones fullname: Lloyd-Jones, Donald M. organization: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois – sequence: 9 givenname: Sadiya S. surname: Khan fullname: Khan, Sadiya S. email: s-khan-1@northwestern.edu organization: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois |
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Keywords | disparities CVD RR CDC APC maternal morbidity rural NHB AHA NHW hypertension race/ethnicity |
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Snippet | Rates of maternal mortality are increasing in the United States with significant rural-urban disparities. Pre-pregnancy hypertension is a well-established risk... |
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SubjectTerms | 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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