Abstract WP354: Racial and Ethnic Disparities in Risk for Pregnancy-Related Stroke: The National Inpatient Sample

Abstract

Background: Significant racial disparities exist in obstetrics. Stroke is a major cause of maternal morbidity and mortality in the US. We sought to determine if the risk for stroke differed by race during delivery and postpartum admissions. Methods: Using the Nationwide Inpatient Sample from 1998 to 2014, we analyzed two separate cohorts: (i) women hospitalized for a delivery, and (ii) women readmitted postpartum. Women age 15-54 were included. Race and ethnicity were characterized as white, black, Hispanic, Asian/Pacific Islander, Native American, other, and unknown. Overall risk for stroke by race was determined. Risk for stroke was further characterized by (i) hemorrhagic stroke, (ii) ischemic stroke, and (iii) stroke associated with preeclampsia or gestational hypertension (PEC/GHTN). Log-linear regression models including demographics, hospital factors, and comorbid risk were used to analyze overall stroke risk. Results: Of 67.7 million delivery and 1.1 million postpartum hospitalizations, 8,241 and 11,073 women were diagnosed with stroke respectively. Black women were at 64% higher risk than white women for stroke during delivery and 66% higher risk for stroke during postpartum admissions (Table). Black women were at 139%, 96%, and 103% higher risk for hemorrhagic, ischemic, and PEC/GHTN-associated stroke during delivery hospitalizations. Risk for black women was also increased postpartum. Relative to white women, Hispanic women were at significantly increased risk for hemorrhagic and PEC/HTN-associated stroke. In adjusted models, black women were at 33% and 37% increased risk for stroke during delivery and postpartum hospitalizations while risk for Hispanic women did not differ. Conclusion: Black women, in particular, are at increased risk for pregnancy-related stroke, both during delivery hospitalizations and postpartum, across clinical scenarios. Broad systemic efforts will be required to reduce disparities in maternal stroke risk.