Association of Race and Ethnicity and Social Factors With Postpartum Primary Care or Cardiology Follow‐Up Visits Among Individuals With Preeclampsia

Abstract

Background Preeclampsia is associated with increased cardiovascular morbidity and death. Primary care or cardiology follow‐up, in complement to routine postpartum obstetric care, provides an essential opportunity to address cardiovascular risk. Prior studies investigating racial differences in the recommended postpartum follow‐up have incompletely assessed the influence of social factors. We hypothesized that racial and ethnic differences in follow‐up with a primary care provider or cardiologist would be modified by income and education. Methods and Results We identified adult individuals with preeclampsia (September 2014 to September 2019) in a national administrative database. We compared occurrence of a postpartum visit with a primary care provider or cardiologist within 1 year after delivery by race and ethnicity using multivariable logistic regression models. We examined whether education or income modified the association between race and ethnicity and the likelihood of follow‐up. Of 18 050 individuals with preeclampsia (aged 31.8±5.7 years), Black individuals (11.7%) had lower odds of primary care provider or cardiology follow‐up within 1 year after delivery compared with White individuals (adjusted odds ratio, 0.77 [95% CI, 0.70–0.85]) as did Hispanic individuals (14.8%; adjusted odds ratio, 0.79 [95% CI, 0.73–0.87]). Black and Hispanic individuals with higher educational attainment were more likely to have follow‐up than those with lower educational attainment (P for interaction=0.033) as did those in higher income brackets (P for interaction=0.006). Conclusions We identified racial and ethnic differences in primary care or cardiology follow‐up in the year postpartum among individuals diagnosed with preeclampsia, a disparity that may be modified by social factors. Enhanced system‐level interventions are needed to reduce barriers to follow‐up care.

Keywords

• follow‐up
• hypertensive disorders of pregnancy
• preeclampsia
• primary care
• racial disparities