Examining the Role of Racial and Neighborhood Context in Hypertensive Disorders of Pregnancy: A Multilevel Analysis

Abstract Purpose Use administrative patient discharge data from 2018–2020 to examine the independent and potentially interactive associations of patient race and area-level indices of the social vulnerability metric with hypertensive disorders of pregnancy. Study Design as well as determining the interactions of patient race with both the total and theme SVI scores. Results Among the 198,507 administrative discharge records, Black women were more likely to have a HDP diagnosis compared to White women residing within the same zip code area (adjusted odds ratio OR = 1.12, 95%CI: 1.07, 1.18). Total SVI score (OR = 1.15, 95%CI: 1.05, 1.25). Controlling for other theme scores, the Socioeconomic Status theme score was associated with a greater likelihood of HDP diagnosis; whereas the Minority Status 95% CI: 1.12–1.44). Conclusion Neighborhood environments inundated with poor social conditions—including structural racism, poverty, residential segregation, systemic bias, and language/communication barriers with providers may significantly increase a person susceptibility to adverse health outcomes. Black women living in socially vulnerable communities face increased risk for HDP, reflecting the compounded effects of these structural inequities. To address the multifaceted social and economic drivers of poor maternal health outcomes, policy reforms are urgently needed at both the federal and state levels. These reforms should include culturally responsive care coordination, expansion of Healthy Food Access programs, and the enactment of maternal health legislation that centers equity and community engagement.