741: Assessment of racial disparities in aspirin prophylaxis for preeclampsia prevention

Abstract

Low-dose aspirin is recommended for preeclampsia prevention in high-risk conditions, including chronic hypertension (cHTN). Black women have higher rates of hypertensive disorders of pregnancy, and whether this is related to disparities in aspirin prophylaxis is unknown. We investigated the relationship between race and counseling, prescription, and adherence to aspirin among a cohort of women with cHTN. This is a retrospective cohort study of women with cHTN who delivered between January 2017 and September 2018. Medical record review was performed to assess counseling, prescription and self-reported adherence to aspirin prophylaxis. Demographic and obstetric outcome data were compared by self-reported race (black vs. all other races) in univariate analysis. Multivariable logistic regression analysis was performed to evaluate the association between race and aspirin adherence. We included 821 women: 296 (36.1%) black women and 525 (63.9%) white or other race women. Black women were more likely to be multiparous, have higher BMI, use tobacco, and have fewer prenatal visits (Table 1). 488 (59.2%) women were counseled and/or given a prescription for aspirin, and 353 (72.3%) of those women reported adherence. Black women were more likely to be counseled and/or prescribed aspirin compared to all other races (64.5% vs 56.6%; p= 0.03), but were less likely to report adherence (65.4% vs 76.8%; p=0.006). Among women who were counseled or prescribed aspirin, after adjustment for total prenatal visits and tobacco use, black race was associated with an aOR 0.61 (95% 0.39-0.94) of adherence with aspirin. In our cohort, black women were more likely than women of other races to receive counseling about aspirin, but rates of uptake were lower. This may be secondary to factors such as health literacy or medical mistrust. Our findings suggest that counseling and prescription of aspirin alone in high-risk black women are not sufficient, and additional research should focus on overcoming contributory social determinants of health.View Large Image Figure ViewerDownload Hi-res image Download (PPT)