Key result
Living in a lower income neighborhood was not associated with a significant difference in intrapartum cardiac events (10% vs. 4%, p=0.16) or preterm delivery (24% vs. 17%, p=0.23) among pregnant patients with cardiac disease.
Why the study?
Cardiovascular disease is the leading cause of pregnancy mortality, but little is known about the impact of social determinants of health in pregnant patients with heart disease.
Does living in a lower income neighborhood increase the rate of cardiac events or preterm delivery in pregnant patients with cardiac disease managed at a cardio-obstetrics program?
Cohort (n=206)
No
Does living in a lower income neighborhood increase the rate of cardiac events or preterm delivery in pregnant patients with cardiac disease managed at a cardio-obstetrics program?
Absolute Event Rate: 10% vs 4%
p-value: p=0.16
Among pregnant patients with heart disease managed in a multidisciplinary cardio-obstetrics program, neighborhood income level was not associated with differences in cardiac events or preterm delivery, suggesting that specialized care may help mitigate socioeconomic disparities.
Should not yet inform risk stratification by neighborhood income; leaves open socioeconomic effects on outcomes in pregnant cardiac patients.
Cardiovascular disease is the leading cause of pregnancy mortality. Socioeconomic and racial disparities in pregnancy are well established. Despite this, little is known about the impact of social determinants of health in pregnant patients with heart disease. This study aims to determine whether pregnant patients with heart disease living in lower income neighborhoods and managed at cardio-obstetrics programs have higher rates of cardiac events or preterm deliveries compared with those living in higher income neighborhoods. This is a retrospective cohort study of 206 patients between 2010 and 2020 at a quaternary care hospital in Northern California. The exposure was household income level based on neighborhood defined by the US Census data. Patients in lower income neighborhoods (N = 103) were 45% Hispanic, 34% White, and 14% Asian versus upper income neighborhoods (N = 103), which were 48% White, 31% Asian, and 12% Hispanic (p < 0.001). There was no significant difference in the rates of intrapartum cardiac events (10% vs. 4%; p = 0.16), postpartum cardiac events (14% vs. 17%; p = 0.7), and preterm delivery (24% vs. 17%; p = 0.23). The rates of antepartum hospitalization were higher for lower income neighborhoods (42% vs 22%; p = 0.004). While there is no significant difference in cardiac events and preterm delivery rates between patients from low versus high income neighborhoods, patients from lower income neighborhoods have higher antepartum hospitalization rates. Earlier identification of clinical deterioration provided by a cardio-obstetrics team may contribute to increased hospitalizations, which might mitigate socioeconomic disparities in outcomes for these pregnant patients with heart disease.
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Carland et al. (2022) conducted a cohort in Cardiac disease in pregnancy (n=206). Lower neighborhood income vs. Upper neighborhood income was evaluated on Intrapartum cardiac events (p=0.16). Living in a lower income neighborhood was not associated with a significant difference in intrapartum cardiac events (10% vs. 4%, p=0.16) or preterm delivery (24% vs. 17%, p=0.23) among pregnant patients with cardiac disease.
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