1063 Social vulnerability may underly racial disparities in peripartum cardiomyopathy outcomes

Abstract

Cardiomyopathy causes 45% of late postpartum maternal deaths in the US. Black women have disproportionately more cases and more severe disease. We examined the geographic distribution of patients with peripartum cardiomyopathy (PPCM) by race and evaluated associations between race and social vulnerability to better understand the known racial disparities in PPCM. We hypothesized that Black patients with PPCM (vs White) were more likely to live in socially vulnerable communities. Retrospective cohort study of women with PPCM per NIH/NHLBI definition from a single center from Jan 2000-Nov 2017, excluding women with PO Box address. The US census tract for each patient’s address was linked to the CDC Social Vulnerability Index (SVI), which on a scale of 0-1 shows a community’s vulnerability to external stresses on health. The SVI includes social factors divided into socioeconomic, household composition, minority status, and housing type/transportation themes. Higher SVI means higher vulnerability. The SVI and select subcomponents were compared by self-reported race. Among 90 women with PPCM (47 White, 43 Black), Black women were less likely to be married and more likely to deliver at an earlier GA and have public insurance. Although ejection fraction (EF) at diagnosis was similar between groups, Black women were more likely to have an EF <= 40% at 6-12 months postpartum. The figure shows geospatial distribution of patients; yellow indicates highest density. Black race was associated with living in areas with greater social vulnerability; SVI was significantly higher among Black women (0.56 vs 0.33, p=.0003) (Table). Black patients lived in areas with more people living in poverty, higher unemployment, and more single parent households (Table). Black women in this cohort of women with PPCM were more likely to live in areas of greater social vulnerability, which may influence health outcomes. Further study is needed to determine whether the racial disparity seen with PPCM is explained in part by these observed geographic disparities.View Large Image Figure ViewerDownload Hi-res image Download (PPT)