Association of Neighborhood Environment Impact on HDP and GDM Among Women in Illinois

Background: Hypertensive Disease of pregnancy (HDP) and Gestational Diabetes Mellitus (GDM) are the leading causes of maternal morbidity and mortality. Both disproportionately affect women of color in the United States. There is growing evidence that neighborhood residential segregation and socioeconomic disadvantage contribute to poor maternal outcomes in women of color at risk for HDP and GDM. In Illinois, the magnitude and burden of HDP and GDM by race/ethnicity and neighborhood disadvantage is unknown. Objectives: The objective of this study is to use discharge data from 2018-2020 to determine if there is variation in the prevalence of HDP and GDM by race/ethnicity in Illinois and examine whether race and ethnicity variation in HDP and GDM is moderated by the zip code linked Area Deprivation Index (ADI). Methods: This retrospective cross-sectional analysis used administrative discharge data from all women patients who had live births in Illinois over a three-year period (2018-2020). Data were linked to a neighborhood-level measure of socioeconomic status, the ADI, to examine the associations with ADI and race/ethnicity by HDP and GDM. Multivariate analyses were performed to control for covariates and determine if associations vary by race/ethnicity and neighborhood socioeconomic disadvantage. Results: Multivariate analyses showed that after adjusting for race/ethnicity and covariates, non-Hispanic Black women had a 1.60 increased risk of being exposed to HDP compared to non-Hispanic white women (OR, 1.60; 95% CI, 1.55-1.65). Similarly, Hispanic (OR, 1.45; 95% CI, 1.40-1.50), Asian or Pacific Islander ((OR, 2.07; 95% CI, 1.97-2.17), and American Indian or Native Alaskan women (OR, 1.43; 95% CI, 1.17-1.74) were at increased risk of being exposed to GDM compared to non-Hispanic White women. There was evidence that the interaction between the ADI quintiles and race/ethnicity were statistically significant (p<0.001). Conclusion: In Illinois, women of color living in the most disadvantaged ADI quintiles carried the greatest burden of both HDP and GDM compared to those living in the least disadvantaged quintile. Therefore, women of color in disadvantaged neighborhood environments who are at greatest risk for HDP and GDM need culturally responsive strategies and interventions to address these health inequities that lead to poor maternal outcomes.