摘要：Objectives. We studied trends of hypertensive disorders of pregnancy by residential socioeconomic status (SES) and racial/ethnic subgroups in New York State over a 10-year period. Methods. We merged New York State discharge data for 2.5 million women hospitalized with delivery from 1993 through 2002 with 2000 US Census data. Results. Rates of diagnoses for all hypertensive disorders combined and for preeclampsia individually were highest among Black women across all regions and neighborhood poverty levels. Although hospitalization rates for preeclampsia decreased over time for most groups, differences in rates between White and Black women increased over the 10-year period. The proportion of women living in poor areas remained relatively constant over the same period. Black and Hispanic women were more likely than White women to have a form of diabetes and were at higher risk of preeclampsia; preeclampsia rates were higher in these groups both with and without diabetes than in corresponding groups of White women. Conclusions. An increasing trend of racial/ethnic disparity in maternal hypertension rates occurred in New York State during the past decade. This trend was persistent after stratification according to SES and other risk factors. Additional research is needed to understand the factors contributing to this growing disparity. Hypertensive diseases of pregnancy are serious maternal morbidities, occurring in 6%–8% of all pregnancies. 1 – 3 Gestational hypertension and preeclampsia are risk factors for other forms of maternal morbidities (as well as neonatal morbidity and mortality), making these diseases of reproductive-aged women a particularly important public health problem. 1 , 2 , 4 , 5 Women with gestational hypertension risk progression to severe hypertension, preeclampsia, or eclampsia. 6 , 7 Women with preeclampsia are predisposed to convulsions, abruptio placentae, disseminated intravascular coagulation, cerebral hemorrhage, pulmonary edema, renal failure, and liver hemorrhage. 2 , 5 , 8 Hypertensive disorders in pregnancy are also known to be associated with an increased risk of developing hypertension and stroke later in life. 9 The risks posed by preeclampsia to the fetus include severe growth retardation, hypoxemia, acidosis, premature birth, and death. 1 , 6 The many risk factors for hypertensive disorders of pregnancy include nulliparity; multifetal gestation; Black race; extremes of reproductive age; obesity; family history of preeclampsia or eclampsia; preeclampsia in a previous pregnancy; presence of diabetes, thrombophilias, essential hypertension, or renal disease 1 , 8 , 10 – 22 ; and other contextual factors (e.g., residential poverty). 20 – 22 Few population-based studies of maternal morbidities exist. Recent studies have provided insight into risks of pregnancy-induced hypertensive disorders, but large subsets of the population were excluded in evaluations of socioeconomic status (SES), body mass index (BMI), gestational diabetes, or maternal health as cofactors. 10 , 21 , 23 , 24 We investigated the associations between contextual socioeconomic variables and hypertensive disorders at the time of labor and delivery for a large state population over a 10-year period. Having 10 years of discharge data for New York State (NYS) gave us the opportunity to study the relation between maternal morbidity—specifically hypertension—and factors related to residential poverty and race/ethnicity. We separated New York City (NYC) from the rest of NYS for all analyses, because these regions differ in terms of racial/ethnic structure, population density, economics, geographic characteristics, and health care delivery systems. This study provides insight into how SES and race/ethnicity may each contribute to the risk for hypertension.
