Primary Submission Category: Reproductive health
Evaluation of the Mediating Role of Neighborhood Deprivation on the Relationship Between Racial Residential Segregation and Hypertensive Disorders of Pregnancy
Authors: DaShaunda Taylor Robert Perera Emily Zimmerman Karen Hendricks-Munoz Derek Chapman
Presenting Author: DaShaunda Taylor*
Background. Hypertensive disorders of pregnancy (HDP) occur in 5-8% of pregnancies in the United States, and recent trends indicate a rise in this condition. HDP can have lifelong and transgenerational consequences, such as poor later-life cardiovascular health for mothers. Research on upstream social determinants of health, including racial residential segregation (RRS) and neighborhood deprivation, suggests that these factors have a substantial influence on perinatal health outcomes. Objective. Hence, this study evaluated the mediating role of neighborhood deprivation on the relationship between RRS and HDP. Methods. Birth certificate data from singleton births in Richmond, Virginia from 2011-2019, neighborhood-level indicators from the U.S. Census Bureau’s 2006-2010 American Community Survey, and the 1990 census were utilized to examine these associations. Principal component analysis was conducted for variable inclusion in the neighborhood deprivation index. Mediation was assessed using multilevel structural equation modeling, specifically path analysis. Results. In analyses stratified by race/ethnicity, the Index of Dissimilarity and the Interaction Index – measures of RRS – were associated with HDP among non-Hispanic White women [odds ratio (OR): 0.63, 95% confidence interval (CI): 0.46-0.88 and OR: 1.73, 95% CI: 1.37-2.17, respectively], and the Index of Dissimilarity was significantly related to HDP for non-Hispanic Black women (OR: 1.60, 95% CI: 1.17-2.19). Among non-Hispanic Black women, higher RRS was associated with increased likelihood of HDP; approximately 70% of this relationship was mediated by neighborhood deprivation. Non-Hispanic White women experienced reduced odds of HDP when RRS was higher. Conclusions. Findings indicate that RRS is detrimental to non-Hispanic Black women but beneficial for non-Hispanic White women regarding HDP likelihood. Future studies should continue to explore the impact of RRS on HDP among differing racial/ethnic groups.