Trends in the Incidence of New-Onset Hypertensive Disorders of Pregnancy Among Rural and Urban Areas in the United States, 2007 to 2019
Background Hypertensive disorders of pregnancy are growing public health problems that contribute to maternal morbidity, mortality, and future risk of cardiovascular disease. Given established rural-urban differences in maternal cardiovascular health, we described contemporary trends in new-onset hy...
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Published in | Journal of the American Heart Association Vol. 11; no. 2; p. e023791 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
England
John Wiley and Sons Inc
18.01.2022
Wiley |
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Abstract | Background Hypertensive disorders of pregnancy are growing public health problems that contribute to maternal morbidity, mortality, and future risk of cardiovascular disease. Given established rural-urban differences in maternal cardiovascular health, we described contemporary trends in new-onset hypertensive disorders of pregnancy in the United States. Methods and Results We conducted a serial, cross-sectional analysis of 51 685 525 live births to individuals aged 15 to 44 years from 2007 to 2019 using the Centers for Disease Control and Prevention Natality Database. We included gestational hypertension and preeclampsia/eclampsia in individuals without chronic hypertension and calculated the age-adjusted incidence (95% CI) per 1000 live births overall and by urbanization status (rural or urban). We used Joinpoint software to identify inflection points and calculate rate of change. We quantified rate ratios to compare the relative incidence in rural compared with urban areas. Incidence (95% CI) of new-onset hypertensive disorders of pregnancy increased from 2007 to 2019 in both rural (48.6 [48.0-49.2] to 83.9 [83.1-84.7]) and urban (37.0 [36.8-37.2] to 77.2 [76.8-77.6]) areas. The rate of annual increase in new-onset hypertensive disorders of pregnancy was more rapid after 2014 with greater acceleration in urban compared with rural areas. Rate ratios (95% CI) comparing incidence of new-onset hypertensive disorders of pregnancy in rural and urban areas decreased from 1.31 (1.30-1.33) in 2007 to 1.09 (1.08-1.10) in 2019. Conclusions Incidence of new-onset hypertensive disorders of pregnancy doubled from 2007 to 2019 with persistent rural-urban differences highlighting the need for targeted interventions to improve the health of pregnant individuals and their offspring. |
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AbstractList | Background Hypertensive disorders of pregnancy are growing public health problems that contribute to maternal morbidity, mortality, and future risk of cardiovascular disease. Given established rural-urban differences in maternal cardiovascular health, we described contemporary trends in new-onset hypertensive disorders of pregnancy in the United States. Methods and Results We conducted a serial, cross-sectional analysis of 51 685 525 live births to individuals aged 15 to 44 years from 2007 to 2019 using the Centers for Disease Control and Prevention Natality Database. We included gestational hypertension and preeclampsia/eclampsia in individuals without chronic hypertension and calculated the age-adjusted incidence (95% CI) per 1000 live births overall and by urbanization status (rural or urban). We used Joinpoint software to identify inflection points and calculate rate of change. We quantified rate ratios to compare the relative incidence in rural compared with urban areas. Incidence (95% CI) of new-onset hypertensive disorders of pregnancy increased from 2007 to 2019 in both rural (48.6 [48.0-49.2] to 83.9 [83.1-84.7]) and urban (37.0 [36.8-37.2] to 77.2 [76.8-77.6]) areas. The rate of annual increase in new-onset hypertensive disorders of pregnancy was more rapid after 2014 with greater acceleration in urban compared with rural areas. Rate ratios (95% CI) comparing incidence of new-onset hypertensive disorders of pregnancy in rural and urban areas decreased from 1.31 (1.30-1.33) in 2007 to 1.09 (1.08-1.10) in 2019. Conclusions Incidence of new-onset hypertensive disorders of pregnancy doubled from 2007 to 2019 with persistent rural-urban differences highlighting the need for targeted interventions to improve the health of pregnant individuals and their offspring. |
Author | Seegmiller, Laura E Grobman, William A Yee, Lynn M Everitt, Ian Khan, Sadiya S Cameron, Natalie A |
AuthorAffiliation | 4 Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL 1 Department of Internal Medicine Northwestern University Feinberg School of Medicine Chicago IL 3 Department of Obstetrics and Gynecology Division of Maternal‐Fetal Medicine Northwestern University Feinberg School of Medicine Chicago IL 2 Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL |
AuthorAffiliation_xml | – name: 2 Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL – name: 4 Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL – name: 1 Department of Internal Medicine Northwestern University Feinberg School of Medicine Chicago IL – name: 3 Department of Obstetrics and Gynecology Division of Maternal‐Fetal Medicine Northwestern University Feinberg School of Medicine Chicago IL |
Author_xml | – sequence: 1 givenname: Natalie A orcidid: 0000-0002-0613-7580 surname: Cameron fullname: Cameron, Natalie A organization: Department of Internal Medicine Northwestern University Feinberg School of Medicine Chicago IL – sequence: 2 givenname: Ian orcidid: 0000-0002-9941-438X surname: Everitt fullname: Everitt, Ian organization: Department of Internal Medicine Northwestern University Feinberg School of Medicine Chicago IL – sequence: 3 givenname: Laura E surname: Seegmiller fullname: Seegmiller, Laura E organization: Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL – sequence: 4 givenname: Lynn M orcidid: 0000-0002-6274-0544 surname: Yee fullname: Yee, Lynn M organization: Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Northwestern University Feinberg School of Medicine Chicago IL – sequence: 5 givenname: William A surname: Grobman fullname: Grobman, William A organization: Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Northwestern University Feinberg School of Medicine Chicago IL – sequence: 6 givenname: Sadiya S orcidid: 0000-0003-0643-1859 surname: Khan fullname: Khan, Sadiya S organization: Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL |
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Keywords | gestational hypertension preeclampsia urban hypertensive disorders of pregnancy rural |
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SubjectTerms | Adolescent Adult Cross-Sectional Studies Eclampsia - epidemiology Female gestational hypertension Humans Hypertension, Pregnancy-Induced - diagnosis Hypertension, Pregnancy-Induced - epidemiology hypertensive disorders of pregnancy Incidence JAHA Spotlight on Pregnancy and its Impact on Maternal and Offspring Cardiovascular Health Original Research Pre-Eclampsia - epidemiology preeclampsia Pregnancy rural United States - epidemiology urban Young Adult |
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Title | Trends in the Incidence of New-Onset Hypertensive Disorders of Pregnancy Among Rural and Urban Areas in the United States, 2007 to 2019 |
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