BACKGROUND AND PURPOSE:

• Butwick et al. (JAMA Network Open, 2020) assessed the extent of statewide variation in the prevalence of chronic hypertension and hypertensive disorders of pregnancy

METHODS:

• Cross-sectional study (September 1, 2019 to February 1, 2020)
• Data source
  • 2017 US birth certificate data
• Population
  • Women with a live birth delivery
• Study design
  • Multivariable logistic regression with median odds ratio (MOR) was used to evaluate statewide variation
• Primary outcomes
  • State-specific prevalence of
    • Chronic hypertension
    • Hypertensive disorders of pregnancy (including pregnancy-induced hypertension and preeclampsia)
    • Eclampsia

RESULTS:

• 3,659,553 women included in the cohort
• Age demographics
  • <20 years: 5.1%
  • 20 to 24 years: 19.9%
  • 25 to 29 years: 29.2%
  • 30 to 34 years: 28.3%
  • 35 to 39 years: 14.3%
  • ≥40 years: 3.2%
• Medical insurance status
  • Medicaid: 42.8%
  • Private insurance: 49.4%
• Chronic hypertension
  • Lowest adjusted prevalence: Hawaii 1.0% (95% CI, 0.9% to 1.2%)
  • Highest adjusted prevalence: Alaska 3.4% (95% CI, 3.0% to 3.9%)
• Hypertensive disorders of pregnancy
  • Lowest adjusted prevalence: Massachusetts 4.3% (95% CI, 4.1% to 4.6%)
  • Highest adjusted prevalence: Louisiana 9.3% (95% CI, 8.9% to 9.8%)
• Eclampsia
  • Lowest adjusted prevalence: Delaware 0.03% (95% CI, 0.01% to 0.09%)
  • Highest adjusted prevalence: Hawaii 2.8% (95% CI, 2.2% to 3.4%)
• The degree of statewide variation was high for eclampsia
  • MOR 2.36 (95% CI, 1.88 to 2.82)
• Variation was more modest between states for
  • Chronic hypertension: MOR 1.27 (95% CI ,1.20 to 1.33)
  • Hypertensive disorders of pregnancy: MOR 1.17 (95% CI, 1.13 to 1.21)

CONCLUSION:

• The prevalence of eclampsia varies by state to a substantial degree
  • The median odds ratio was 2.4-fold higher if the same woman delivered in a US state with a higher vs lower prevalence of eclampsia
• The authors suggest that

These data can inform future public health inquiries to identify reasons for the state-level variability in eclampsia prevalence

Learn More – Primary Sources:

Evaluation of US State–Level Variation in Hypertensive Disorders of Pregnancy

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