A preliminary study to be presented at the American Heart Association's Scientific Sessions 2024 has found that differences in socioeconomic status during early pregnancy may account for the majority of cardiovascular health disparities among women of different racial and ethnic groups years after giving birth. The research, which examined over 4,000 first-time mothers, assessed how social determinants of health in early pregnancy contribute to racial and ethnic differences in maternal heart health up to seven years after delivery. Factors analyzed included education level, income, health insurance status, and health literacy.
Using data from the nuMoM2b-HHS study, researchers calculated cardiovascular health scores for participants based on the American Heart Association's Life's Essential 8 metrics. These include measures like body mass index, blood pressure, cholesterol, diet, and physical activity. Each woman was assigned a heart health score from 0 to 100, with higher scores indicating better cardiovascular health. The analysis revealed that after adjusting for demographic, socioeconomic and psychosocial factors, white mothers had an average cardiovascular health score 12.2 points higher than Black mothers and 3.3 points higher than Hispanic mothers.
However, when socioeconomic data for Black women was adjusted to match their white counterparts, their cardiovascular health score increased by 6.6 points, effectively eliminating over 50% of the disparity between the two groups. Similarly, when Hispanic women's socioeconomic data was adjusted to align with white participants, their scores increased by 3.9 points, completely erasing the gap between white and Hispanic women. Study first author Xiaoning 'Jack' Huang, Ph.D., of Northwestern University's Feinberg School of Medicine, expressed surprise at the extent to which socioeconomic status explained cardiovascular health differences years after childbirth.
He suggested that in an ideal society with similar socioeconomic status across racial-ethnic groups, most health disparities could potentially be eliminated. The findings underscore the importance of enhancing accessibility and affordability of health care for socioeconomically disadvantaged individuals. The researchers point to initiatives like Medicaid extension and expansion as potential ways to promote health equity across the life course. This research comes at a critical time, as the United States is currently the only developed country with an increasing maternal death rate.
Recent trends indicate that Black, non-Hispanic women are disproportionately affected by poor care before, during, and after childbirth. The study's results support the need for public health policies that address the impact of structural racism on maternal health and healthcare in the United States. By identifying the significant role of socioeconomic status in postpartum cardiovascular health, the research provides valuable data to support efforts to improve affordable preventive postpartum care, such as extending Medicaid postpartum coverage to one year. While the observational nature of the study means it can only establish association rather than causation, the findings highlight the critical importance of addressing social determinants of health to improve maternal cardiovascular outcomes and reduce racial and ethnic disparities in healthcare.
