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How race is associated with adverse outcomes in the setting of preeclampsia is not well characterized. The objective of this study was to assess maternal outcomes by race in the setting of preeclampsia.
This retrospective cohort study utilized the Nationwide Inpatient Sample (NIS) from 2012 to 2014. Women age 15 to 54 with preeclampsia were included. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander, Native American, other, and unknown. Overall risk for severe morbidity based on CDC criteria was analyzed along with specific outcomes such as stroke, acute heart failure or pulmonary edema (AHF/PE), eclampsia, and acute renal failure. Risk for severe morbidity was stratified by comorbid risk and compared by race. Log-linear models were created to assess risk for severe morbidity accounting for comorbidity, demographic, and hospital factors with risk ratios (RR) and 95% confidence intervals (CI) as measures of effect.
101,741 women with preeclampsia from 2012 to 2014 were included in this analysis. Risk for severe morbidity was significantly higher among non-Hispanic black women (9.8%) than non-Hispanic white, Hispanic, and all other women respectively (6.1%, 7.7%, and 7.5% respectively, p<0.01). For non-Hispanic black compared to non-Hispanic white, Hispanic, and all other women risk was higher for stroke (17.1 versus 6.5, 12.7, and 9.3 per 10,000 deliveries respectively, p<0.01) and AHF/PE (56.2 versus 32.7, 30.2, and 38.4 per 10,000 deliveries respectively, p<0.01 (Figure 1). Non-Hispanic black women were also more likely than non-Hispanic white women to experience renal failure (136.4 versus 60.4 per 10,000 deliveries, p<0.01) and eclampsia (171.1 versus 133.6 per 10,000 deliveries, p<0.01) (Figure 2). Adjusting for comorbidity, demographic, and hospital factors, black women remained at higher risk for severe morbidity (RR 1.60 95% CI 1.51-1.69). Risk for death was higher for black compared to non-black women (121.8 per 100,000 deliveries, 95% CI 69.7-212.9 versus 24.1 per 100,000 deliveries, 95% CI 14.6-39.8, respectively, p<0.01).
Black women were at higher risk for severe morbidity and mortality associated with preeclampsia. Addressing these differentials may be important in efforts to reduce overall racial disparities.