Neighborhood Disinvestment and Racial and Ethnic Disparities in Peripartum Cardiomyopathy in California, From 2004 To 2019

Background: Peripartum cardiomyopathy (PPCM) is a rare medical condition presenting as idiopathic heart failure. The aim of this study was to (1) examine the contribution of neighborhood disinvestment to PPCM risk and to racial and ethnic disparities in PPCM; (2) examine the extent to which sociodemographic factors and chronic hypertension explain these outcomes; and (3) describe severe maternal morbidity cases and the timing of PPCM.

Methods: We conducted an observational cohort study using vital records longitudinally linked with hospital discharge records for mothers and infants up to 9 months postpartum for births in California from 1997 to 2019. Using the Neighborhood Deprivation Index as a proxy measure for neighborhood disinvestment, we sequentially adjusted multivariable logistic regression models to estimate the association of Neighborhood Deprivation Index and race and ethnicity with PPCM.

Results: Our study included 7 354 662 births and 918 (0.012%) PPCM cases. Those residing in neighborhoods with higher disinvestment had an increased odds of PPCM (OR [95% CI] Quartile 2: 1.2 [1.0-1.5]; Quartile 3: 1.7 [1.4-2.1]; Quartile 4: 1.5 [1.2-1.9]). When considering the contribution of Neighborhood Deprivation Index to racial and ethnic disparities in PPCM, the odds ratio slightly decreased for Non-Hispanic Black births from 3.8 (3.1-4.6) to 3.4 (2.8-4.1). For chronic hypertension in Non-Hispanic Black births there was a slight decrease in odds from 3.4 (2.8-4.1) to 3.1 (2.6-3.8). The severe maternal morbidity indicator with the highest frequency was pulmonary edema/acute heart failure.

Conclusions: Our results show that neighborhood deprivation and pre-pregnancy hypertension partially explain PPCM risk but does not explain the racial or ethnic disparity. Future research should examine the impact of specific measures of neighborhood deprivation on the racial and ethnic disparity in outcomes such as PPCM.