Racial Residential Segregation and Hypertensive Disorder of Pregnancy among Women in Chicago: Analysis of Electronic Health Record Data

Stephanie L. Mayne*, Disha Yellayi, Lindsay R. Pool, William A. Grobman, Kiarri N. Kershaw

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

BACKGROUND Racial residential segregation is associated with higher rates of chronic hypertension, as well as greater risk of preterm birth and low birthweight. However, few studies have examined associations between segregation and hypertensive disorder of pregnancy (HDP). METHODS Electronic health records from 4,748 singleton births among non-Hispanic black women at Prentice Women's Hospital in Chicago, IL (2009-2013) were geocoded to the census tract level. Residential segregation was measured using the G i ∗ statistic, a z-score measuring the extent to which each individual's neighborhood composition deviates from the composition of the larger surrounding area. Segregation was categorized as low (z < 0), medium (z = 0-1.96) or high (z > 1.96). We estimated cross-sectional associations of segregation with HDP using multilevel logistic regression models with census tract random intercepts. Models adjusted for neighborhood poverty and maternal characteristics. We also examined effect modification by neighborhood poverty. RESULTS Overall, 27.2% of women lived in high segregation, high-poverty neighborhoods. Racial residential segregation was not associated as a main effect with HDP in models adjusting for neighborhood poverty and maternal characteristics. However, at higher levels of neighborhood poverty (>20%), women living in high-and medium-segregated neighborhoods had greater odds of HDP relative to those in low-segregation neighborhoods (P interaction: 0.002). CONCLUSIONS In this sample of non-Hispanic black women in Chicago, racial residential segregation was associated with greater prevalence of HDP among those living in higher poverty neighborhoods. Understanding sources of heterogeneity in the relationship between segregation and health will help refine targeted intervention efforts to reduce disparities.

Original languageEnglish (US)
Pages (from-to)1221-1227
Number of pages7
JournalAmerican Journal of Hypertension
Volume31
Issue number11
DOIs
StatePublished - Oct 15 2018

Keywords

  • blood pressure
  • electronic health records
  • hypertension
  • hypertensive disorder of pregnancy
  • maternal health
  • neighborhood poverty
  • racial residential segregation

ASJC Scopus subject areas

  • Internal Medicine

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