910 Geographic disparities in peripartum cardiomyopathy outcomes

Abstract

Cardiomyopathy causes 45% of late postpartum pregnancy-related deaths in the US. We aimed to identify geographic distribution of and disparities in peripartum cardiomyopathy (PPCM) outcomes, hypothesizing that community factors and social vulnerability are associated with worse outcomes. Retrospective cohort study of women with PPCM (per NIH/NHLBI definition) from Jan 2000-Nov 2017 at a single center, excluding women with a PO Box address. Severe PPCM (vs less severe PPCM) was defined as ejection fraction (EF) < 30%, death, or need for ICU, LVAD, ICD, or transplant. The US census tract for the 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 SVI components were compared among patients by PPCM severity. Of 90 patients with PPCM, 56 met severe criteria. At baseline, women with and without severe PPCM had similar age, marital status, payor type, tobacco use, GA at delivery, and mode of delivery. Women with severe PPCM were more likely to be Black (vs White) (59% vs 29%, p < 0.007) and less likely to recover EF to > 55% by 12 months (36% vs 62%, p=0.02). The figure shows geospatial distribution of patients; yellow indicates highest density. Patients with severe PPCM were more likely to live in areas with a higher social vulnerability index and with more residents in poverty, unemployed, without a high school diploma, in single parent households, of minority status, without a vehicle, and in institutionalized group quarters (Table). Median income was lower in communities of women with severe PPCM (Table). Patients with severe PPCM outcomes were more likely to live in communities with greater social vulnerability. To reduce disparities and maternal mortality, resources may need to be directed to our socially vulnerable communities.View Large Image Figure ViewerDownload Hi-res image Download (PPT)