Racial Disparities Affect Primary Care, Cardiology Follow-Up Rates in Preeclampsia

Black and Hispanic patients with preeclampsia are significantly less likely to receive postpartum primary care or cardiology follow-up within 1 year after delivery than individuals of White race, according to a study in the Journal of the American Heart Association.

Researchers analyzed data from Optum’s deidentified Clinformatics Data Mart Database, which includes individuals with commercial and Medicare Advantage insurance coverage in the United States.

The study enrolled participants aged 18 years and older with any delivery type and a preeclampsia diagnosis no more than 6 months before delivery from September 2014 to September 2019. They were followed prospectively for 1 year, with follow-up concluding in March 2020.

The primary outcome was a follow-up visit with a primary care provider (PCP) or cardiologist by 1 year postpartum.

The cohort included 18,050 individuals (mean age, 31.8±5.7 years) diagnosed with preeclampsia, of whom 11.7% were non-Hispanic Black ethnicity and 14.8% were of Hispanic ethnicity.

Non-Hispanic Black individuals were less likely to have a follow-up visit with a PCP or cardiologist (adjusted odds ratio [aOR], 0.77; 95% CI, 0.70-0.85). Hispanic individuals also were less likely to have a follow-up with a PCP or cardiologist within 1 year postdelivery (aOR, 0.79; 95% CI, 0.73-0.87). In sensitivity analyses that omitted 8557 participants with chronic hypertension (13.6% Black), similar findings were observed.

Black patients were 14% less likely to have a follow-up with a PCP or cardiologist during a median 25 (IQR, 17-38) weeks postpartum vs White patients in a median 26 (IQR, 18-40) weeks postpartum. Hispanic individuals were 12% less likely to have follow-up in a median 25 (IQR, 17-38) weeks postpartum vs White individuals.

Education attainment modified the association for race and ethnicity with PCP and cardiology follow-up in participants who had preeclampsia (P_interaction =.033). Black and Hispanic individuals who had less than or equal to a high school diploma or some college had reduced odds of follow-up compared with White individuals with the same education level.

Income modified the association between race and ethnicity with follow-up in patients with preeclampsia (P_interaction =.006). In general, higher income (≥$50,000 annually) decreased racial and ethnic differences regarding PCP or cardiology follow-up. Hispanic participants who earned more than $100,000 per year were less likely to have PCP or cardiology follow-up vs White individuals in the same income level.

Limitations of the study include the potential for misclassification of demographic variables and follow-up status, and the analysis evaluated only commercially insured patients and those covered by Medicare Advantage.

“Addressing disparities in follow-up care for individuals with preeclampsia is critical for long-term blood pressure management and cardiovascular disease prevention,” wrote the study authors.

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on The Cardiology Advisor