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Primary Submission Category: Reproductive health
Structural racism and racial gaps in hypertensive of disorders of pregnancy in Georgia
Authors: Sheree Boulet, Reem Abdelghany, Ran Zhang, Rachel Kienle, Kaitlyn Stanhope, Jasmin Eatman, Michael Kramer, Sierra Carter,
Presenting Author: Sheree Boulet*
Objective: We aimed to identify latent constructs of structural racial discrimination (SRD) and evaluate their associations with Black-white disparities in rates of hypertensive disorders of pregnancy (HDP) in Georgia.
Methods: Using 12 county-level indicators of SRD representing historic, criminal justice, residential, and political domains, we conducted a Bayesian exploratory factor analysis (EFA) to identify latent factors and estimate county scores. We linked the scores to 2020-2024 Georgia natality data and used Bayesian conditional autoregressive linear models to estimate associations between factor scores (categorized into tertiles) and Black-white differences in rates of HDP among birthing people aged 15-44, adjusting for age, urbanicity, and county Black-white voting ratios. HDP included chronic and gestational hypertension and eclampsia as reported on the birth certificate.
Results: The EFA identified two latent factors: Historic and Polarization. Among 206,438 births to Black individuals and 265,693 births to white individuals, HDP rates were 15.5% and 13.1%, respectively. The mean county-level Black-white risk difference in HDP rates was 28.9 per 1000 births. Compared with the first tertile of Historic factor scores, scores in the second (T2) and third (T3) tertiles were associated with increased Black-white HDP disparities (T2: 6.2, 95% CI: 3.0-15.4; T3: 5.0, 95% CI: 5.4-15.4). Increasing Polarization scores were similarly associated with widening Black-white disparities in HDP (T2: 9.5, 95% CI: 0.2-18.4; T3: 9.8, 95% CI: 1.5-21.1).
Conclusions: Structural racism contributes to maternal racial disparities in HDP, particularly in states like Georgia where historic practices remain embedded in contemporary legal, political, and social systems.