Abstract P869: Racial Disparities in Pregnancy-Associated Stroke, a US Nationwide Cohort Study

Abstract

Introduction: Pregnancy-associated stroke (PAS) is a rare event but is associated with high morbidity and mortality. Understanding racial disparities in outcomes may help improve care in susceptible populations and shed light on areas of possible targeted improvement. Methods: Pregnant and post-partum women hospitalized from January 2002 to December 2017 were identified from the Nationwide Inpatient Sample. White and Black women were included in the current study. PAS was identified using the International Classification of Diseases (ICD) 9 and 10 revisions. In-hospital mortality was the primary outcome. Multivariate regression analysis was used for Adjusted Odds Ratio (aOR) and 95% Confidence Interval (CI) to adjust for differences in baseline and pregnancy-related comorbidities. Results: Among 38,797,752 pregnant and post-partum women, 21.9% were black. A total of 10,959 women (0.03%) suffered from PAS. Of women with PAS, 4,521 (41.3%) were Black. Black women with PAS had a higher in-hospital mortality rate compared to white women (7.8% vs. 5.0%, P< 0.001). A significant disparity was noted in the risk of mortality by age groups where black women of ages 18-24 with PAS had a higher aOR of mortality 2.10, 95% (confidence interval) CI (1.88-2.35) compared to white women, ages 25-29 had aOR of 2.75, 95% CI (2.46-3.07), ages 30-34 had aOR of 3.94, 95% CI (3.50-4.43), ages 35-40 had aOR of 3.73, 95% CI (3.25-4.29), and ages 40 and older had aOR of 1.27, 95% CI (1.08-1.51). A significant difference was noted when stratifying outcome by income as black women in the lowest quartile of income had an aOR of 1.91, 95% CI (1.74-2.10), while those in the highest quartile of income had OR of 2.38, 95% CI (2.02-2.80). Conclusions: Black women with PAS were associated with higher in-hospital mortality compared with the White counterparts. These differences were observed mainly among the younger age groups. Targeted interventions are needed to minimize these observed racial differences.