Abstract 11843: Association of Individual- And Neighborhood-Level Factors With Racial and Ethnic Differences in Cardiovascular Health During Early Pregnancy

Abstract

Introduction: Individual and neighborhood-level factors are associated with racial and ethnic differences in cardiovascular health (CVH). To identify strategies to improve maternal health, we determined the relative contributions of these factors to racial and ethnic differences in early pregnancy CVH. Methods: We included pregnant individuals from nuMoM2b, a multicenter cohort who self-identified as Hispanic, non-Hispanic Black (NHB), or non-Hispanic White (NHW). We applied a Blinder-Oaxaca decomposition to evaluate the extent to which socioeconomic and psychosocial factors, discrimination experiences, and area deprivation index statistically explain racial and ethnic differences in CVH (0-8 points, based on body mass index, blood pressure, diabetes, and smoking status) in the first trimester. This method utilizes a counterfactual approach to estimate the mean change in CVH in the Hispanic and NHB groups if covariates were set to the mean in the referent group (NHW). We calculated the percent explained by each factor by dividing the predicted mean change by the total CVH difference between groups*100. Results: Of 5,695 pregnant individuals, 12.3% were Hispanic, 8.9% NHB and 78.8% NHW. Mean CVH scores were 6.4 for Hispanic, 6.0 for NHB and 6.6 for NHB individuals. After adjusting for age and immigrant status, mean CVH scores were lower (worse) by 0.83 (95% CI 0.51-1.04) points in NHB individuals and 0.49 (95% CI 0.28-0.60) points in Hispanic individuals compared with NHW individuals. Differences in social and psychologic factors explained 87% of NHB-NHW differences and 71% of Hispanic-NHW differences in CVH scores (FIGURE) ; socioeconomic factors explained the greatest difference in CVH between groups. Conclusions: Individual- and neighborhood-level social and psychologic factors statistically explained a clinically meaningful difference in CVH among racial and ethnic groups, which may inform strategies to optimize health in pregnant individuals.