Objective: To determine whether community-level social determinants of health are associated with hypertensive disorders of pregnancy (HDP).
Methods: This is a secondary analysis from the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be. We evaluated three community-level exposures using home addresses geocoded at the census-tract level: 1) socioeconomic disadvantage by the 2015 Area Deprivation Index (ADI); 2) food insecurity by the USDA Food Access Research Atlas; and 3) less walkability by the EPA National Walkability Score. The outcome was new onset HDP. Poisson regression was used to estimate adjusted relative risks (aRR).
Results: Of 9,062 individuals, 33.6% were in the highest tertile of ADI, 24.5% lived with food insecurity, and 66.3% lived in a less walkable neighborhood. 13.0% were diagnosed with HDP. Individuals living in a community with higher socioeconomic disadvantage, (aRR T2: 1.26; 95% CI: 1.10, 1.44; and T3: 1.19; 95% CI: 1.02, 1.38), food insecurity (aRR: 1.15; 95% CI: 1.02, 1.29), and less walkability (aRR: 1.21; 95 CI: 1.07, 1.36) were at higher risk of developing HDP compared with those who did not.
Conclusions: Community-level social determinants of health, including socioeconomic disadvantage, food insecurity, and low walkability, were associated with increased risk of HDP among nulliparous individuals.
T.Bank: None. W.Grobman: None. J.Wu: None. C.Lynch: None. K.K.Venkatesh: None.
