The association of birthweight and the racial disparity in hypertension among black and white medicaid beneficiaries

Abstract

A substantial racial disparity is evident on the population level with African Americans maintaining an excess burden of hypertension-related conditions such as stroke, end-stage renal disease and congestive heart failure, as well as a higher prevalence of high blood pressure. African Americans also have a two-fold risk of low birthweight. The impact of birthweight on the racial disparity in hypertension was assessed using the South Carolina Medicaid beneficiary cohort for the 1993–1996 time period. Beneficiary diagnosis, treatment and pharmacy data were matched to the birthweight reported on the birth certificate. Hypertensive beneficiaries (ages 30 through 36) were identified from adjudicated claims and compared with non-hypertensive beneficiaries. A total of 8085 beneficiaries (76% African American and 63% female) with birthweights were used in the analyses. African American beneficiaries were more likely to be hypertensive and to have low birthweight. The association of birthweight and hypertension varied by race, sex, and age with strongest association among white males. The results of these analyses suggest fetal and early life influences may contribute to the racial disparity in hypertension in adults.