African ancestry mothers had a significantly higher risk of presenting with postpartum peripartum cardiomyopathy compared to white mothers (OR 3.61, p<0.001).
Observational (n=5,163,389)
Yes
Does social vulnerability disproportionately affect the risk of postpartum peripartum cardiomyopathy across different racial groups?
Social determinants of health, particularly housing and transportation access, disproportionately increase the risk of postpartum peripartum cardiomyopathy in African ancestry mothers.
Effect estimate: OR 3.61
p-value: p=<0.001
Abstract Background Peripartum cardiomyopathy (PPCM) is a leading cause of maternal mortality throughout the world with poor outcomes significantly correlated with time to presentation. Additionally, PPCM disproportionately affects populations of African ancestry (AA) and patients residing in areas of high social vulnerability. In the US, census data is used to calculate a social vulnerability index (SVI), which consists of four themes: socioeconomic status, household age composition, minority status, and housing or transportation access. A recent 20-year study found both black and white patients with PPCM with higher global SVI scores had higher age-adjusted mortality rates, but it is not known whether themes of social vulnerability affect race groups differently. Purpose To use regional hospitalization data from the US to characterize racial differences in social determinants of health that influence postpartum presentation of PPCM. Methods Public discharge data which included hospital readmission data were obtained from the Agency of Healthcare Research and Quality for Arizona (2003-2007), Florida (2004-2013), and Washington (2003-2012). Patient, pregnancy, obstetric characteristics and delivery were determined using ICD-9 CM codes. Post-delivery presentation was defined as PPCM coded after discharge within 150 days of delivery. The overall SVI and 4 component themes were obtained at the zip code level from the Centers for Disease Control. Patient characteristics including social vulnerability were stratified by white, AA, and Hispanic background, and associations with PPCM were determined using logistic regression. Results In total 5,163,389 delivering mothers were identified. 2724 mothers were diagnosed with PPCM, 1569 (57.6%) of which were rehospitalized after discharge for PPCM. Compared with white mothers, AA mothers had an increased risk of presenting with PPCM postpartum (odds ratio (OR) 3.61, p 0.001), whereas Hispanic (OR 0.29, p0.001), Asian (OR 0.61, p=0.04), and Native American mothers (OR 0.13, p=0.04) had a lower risk of PPCM in univariable analysis. Race differences were similar in multivariable analysis (Figure). Socioeconomic status, household composition, and housing + transportation access were all significantly higher in PPCM patients (p0.001 for all) when controlling for known PPCM medical risk factors, whereas minority status did not correlate with PPCM (p=0.131). Further race stratification showed that high household age composition disproportionately increased risk of post-partum PPCM in white (OR 2.60, p=0.013) and Hispanic mothers (OR 6.75, p=0.012), while decreased housing and transportation access disproportionately increased risk of PPCM for black patients (OR 4.09, p=0.001). Conclusion Social determinants of health disproportionately affect patients by race and can increase the risk for developing PPCM. However, higher SVIs do not appear to have a significant influence on PPCM time to presentation.Multivariable odds SVI Postpartum PPCM
Sompel et al. (Sat,) conducted a observational in Peripartum cardiomyopathy (PPCM) (n=5,163,389). African ancestry and social vulnerability vs. White mothers was evaluated on Postpartum presentation of PPCM (OR 3.61, p=<0.001). African ancestry mothers had a significantly higher risk of presenting with postpartum peripartum cardiomyopathy compared to white mothers (OR 3.61, p<0.001).