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. 2022 Jan 18;11(2):e023791.
doi: 10.1161/JAHA.121.023791. Epub 2022 Jan 11.

Trends in the Incidence of New-Onset Hypertensive Disorders of Pregnancy Among Rural and Urban Areas in the United States, 2007 to 2019

Natalie A Cameron  1 , Ian Everitt  1 , Laura E Seegmiller  2 , Lynn M Yee  3 , William A Grobman  3 , Sadiya S Khan  2   4
Affiliations

Trends in the Incidence of New-Onset Hypertensive Disorders of Pregnancy Among Rural and Urban Areas in the United States, 2007 to 2019

Natalie A Cameron et al. J Am Heart Assoc. .

Abstract

Background Hypertensive disorders of pregnancy are growing public health problems that contribute to maternal morbidity, mortality, and future risk of cardiovascular disease. Given established rural-urban differences in maternal cardiovascular health, we described contemporary trends in new-onset hypertensive disorders of pregnancy in the United States. Methods and Results We conducted a serial, cross-sectional analysis of 51 685 525 live births to individuals aged 15 to 44 years from 2007 to 2019 using the Centers for Disease Control and Prevention Natality Database. We included gestational hypertension and preeclampsia/eclampsia in individuals without chronic hypertension and calculated the age-adjusted incidence (95% CI) per 1000 live births overall and by urbanization status (rural or urban). We used Joinpoint software to identify inflection points and calculate rate of change. We quantified rate ratios to compare the relative incidence in rural compared with urban areas. Incidence (95% CI) of new-onset hypertensive disorders of pregnancy increased from 2007 to 2019 in both rural (48.6 [48.0-49.2] to 83.9 [83.1-84.7]) and urban (37.0 [36.8-37.2] to 77.2 [76.8-77.6]) areas. The rate of annual increase in new-onset hypertensive disorders of pregnancy was more rapid after 2014 with greater acceleration in urban compared with rural areas. Rate ratios (95% CI) comparing incidence of new-onset hypertensive disorders of pregnancy in rural and urban areas decreased from 1.31 (1.30-1.33) in 2007 to 1.09 (1.08-1.10) in 2019. Conclusions Incidence of new-onset hypertensive disorders of pregnancy doubled from 2007 to 2019 with persistent rural-urban differences highlighting the need for targeted interventions to improve the health of pregnant individuals and their offspring.

Keywords: gestational hypertension; hypertensive disorders of pregnancy; preeclampsia; rural; urban.

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Figures

Figure 1
Figure 1. Trends in the age‐adjusted incidence of new‐onset hypertensive disorders of pregnancy per 1000 live births and average annual percent change in rural and urban areas in the United States, 2007 to 2019.
The incidence of hypertensive disorders of pregnancy approximately doubled in both rural and urban areas from 2007 to 2019 with accelerating rates since 2014. The rural‐urban gap decreased over the study period because of more rapid increases in the rates of hypertensive disorders of pregnancy among individuals with live births in urban compared with rural areas.
Figure 2
Figure 2. Trends in the incidence of new‐onset hypertensive disorders of pregnancy per 1000 live births in rural and urban areas by age group in the United States, 2007 to 2019.
The incidence of hypertensive disorders of pregnancy increased from 2007 to 2019 in each age group.
Figure 3
Figure 3. Trends in the incidence of new‐onset hypertensive disorders of pregnancy per 1000 live births in rural and urban areas by race and ethnicity in the United States, 2007 to 2019.
The incidence of hypertensive disorders of pregnancy increased from 2007 to 2019 in each racial and ethnic group. The incidence was highest among individuals with live births who identified as American Indian/Alaskan Native or Non‐Hispanic Black.
Figure 4
Figure 4. Trends in the incidence of new‐onset hypertensive disorders of pregnancy per 1000 live births in rural and urban areas by geographic region in the United States, 2007 to 2019.
The incidence of hypertensive disorders of pregnancy increased from 2007 to 2019 in rural and urban areas in each United States census region.
See this image and copyright information in PMC

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