Racial/Ethnic Disparities in the Association Between Preeclampsia Risk Factors and Preeclampsia Among Women Residing in Hawaii

Abstract

Objective To assess differences in the rates of preeclampsia among a multiethnic population in Hawaii. Methods We performed a retrospective study on statewide inpatient data for delivery hospitalizations in Hawaii between January 1995 and December 2013. Multivariable logistic regression was used to assess the impact of maternal race/ethnicity on the rates of preeclampsia after adjusting for age, multiple gestation, multiparity, chronic hypertension, pregestational diabetes, obesity and smoking. Results A total of 271,569 hospital discharges for delivery were studied. The rates of preeclampsia ranged from 2.0% for Chinese to 4.6% for Filipinos. Preeclampsia rates were higher among Native Hawaiians who are age <35 and non-obese (OR, 1.54; 95% CI, 1.43-1.66), age ≥35 and non-obese (OR, 2.31; 95% CI, 2.00-2.68), age ≥35 and obese (OR, 1.80; 95% CI, 1.24-2.60); other Pacific Islanders who are age <35 and non-obese (OR, 1.40; 95% CI, 1.27-1.54), age ≥35 and non-obese (OR, 2.18; 95% CI, 1.79-2.64), age ≥35 and obese (OR, 1.68; 95% CI, 1.14-2.49); and Filipinos who are age <35 and non-obese (OR, 1.55; 95% CI, 1.43-1.67), age ≥35 and non-obese (OR, 2.26; 95% CI, 1.97-2.60), age ≥35 and obese (OR, 1.64; 95% CI, 1.04-2.59) compared to whites. Pregestational diabetes (OR, 3.41; 95% CI, 3.02-3.85), chronic hypertension (OR, 5.98; 95% CI, 4.98-7.18), and smoking (OR, 1.19; 95% CI, 1.07-1.33) were also independently associated with preeclampsia. Conclusion In Hawaii, Native Hawaiians, other Pacific Islanders and Filipinos have a higher risk of preeclampsia compared to whites. For these high-risk ethnic groups, more frequent monitoring for preeclampsia may be needed.

Prevalence of Chronic Conditions and Multimorbidities in a Geographically Defined Geriatric Population With Diverse Races and Ethnicities

“…Asian and PI, two of the common racial groups in Hawaii (2010 Census Hawaii: Asian 38.6%, and Native Hawaiian and other PIs 10.0%), were collapsed into the Asian/PI race variable in Medicare data. As Hawaii is the most racially and ethnically diverse state and studies showed significant differences in health outcomes with more detailed race/ethnicity (Lim et al, 2015; Nakagawa, Lim, Harvey, Miyamura, & Juarez, 2016), having more racial/ethnic categories would allow for more meaningful comparisons. Third, due to the nature of Medicare data, we could not assess whether beneficiaries had chronic conditions before they enrolled in the Medicare plan, which could lead to a potential underestimation.…”

Preeclampsia Prevalence, Risk Factors, and Pregnancy Outcomes in Sweden and China

“… 6 , 7 The association of ethnicity with preeclampsia severity has generally been investigated in within-country studies in multicultural settings, comparing mostly African American, Hispanic, and White subgroups in the United States. 8 , 9 In addition to the sparsity of data about Asian or Chinese women as an ethnic subgroup in those studies, there are no population-based studies of preeclampsia among women in China. However, the many racial and ethnic differences that were noted in a recent review 10 suggest that there could be important differences between women in China and Europe.…”

Maternal cardiovascular-related single nucleotide polymorphisms, genes, and pathways associated with early-onset preeclampsia

“…The majority of prior work on the genetic associations with early-onset preeclampsia have involved White populations [4]. This study includes racial subgroups that have been relatively unstudied, including the Filipino and Pacific Islander populations that demonstrate an increased risk for gestational hypertension and preeclampsia [7,38]. Sun et al (2009) identified 72 genes with differential expression in six Chinese Han women with early-onset severe preeclampsia [39].…”

“…The association between cardiovascular and metabolic disease and preeclampsia implies the presence of underlying genetic mechanisms common to the conditions, and elucidation of these mechanisms may improve the understanding of the pathogenesis of preeclampsia as well as future cardiovascular and metabolic disease risk assessment in women with a history of preeclampsia. In addition, there are racial differences in the rates of preeclampsia that persist after adjusting for other risk factors, with Native Hawaiian and other Pacific Islanders (NHOPI) and Filipinos demonstrating increased risk [7]. Thus, the genetics underlying preeclampsia may differ between racial groups.…”