Health Equity/Community Health
Poster Session 2
Taylor S. Freret, MD
Massachusetts General Hospital
Cambridge, MA, United States
Allison Bryant Mantha, MD
Massachusetts General Hospital
Boston, MA, United States
Kaitlyn E. James, PhD, MPH (she/her/hers)
Massachusetts General Hospital
Boston, MA, United States
Anjali J. Kaimal, MD (she/her/hers)
Professor and Vice Chair of Clinical Operations, Department of OBGYN
University of South Florida Morsani College of Medicine
Tampa, FL, United States
Alexander Melamed, MD, MPH
Massachusetts General Hospital
Boston, MA, United States
.jpg "Mark A. Clapp, MD, MPH (he/him/his) photo")
Mark A. Clapp, MD, MPH (he/him/his)
Massachusetts General Hospital
Boston, MA, United States
In 2021, updated USPSTF guidelines emphasized that Black race is associated with higher incidence of and morbidity from preeclampsia; ACOG also updated guidelines noting that Black race as a risk factor is a proxy for racism. It is unclear whether the change in framing of these recommendations was associated with changes in LDA use in this population.
Study Design:
Repeated cross-sectional analysis of nulliparous patients delivering at ≥24 weeks gestation from 2017-2022 in one healthcare system with an indication for LDA regardless of race (any high-risk factor or 2+ moderate-risk factors excluding Black race). USPSTF risk factors and aspirin use were obtained from the medical record. The primary outcome was LDA documented on the medication list. The primary exposure was Black race (vs white race). Exact matching was performed on risk factors, year of delivery, and site, stratified by race. A patient-level difference-in-difference (DID) analysis using linear regression was performed among matched patients. The pre-period included patients delivering before 2022; the post-period during 2022.
Results:
The cohort included 13,221 patients, of whom 9,822 self-identified as white or Black race. After exact matching, 2,614 patients remained (26.6%). The overall rate of LDA use was 12.2%; 27.3% among patients for whom LDA was recommended and 5.0% among those for whom it should be considered. LDA use increased over time in both cohorts (Figure). In the pre-period, LDA use was 3.1 percentage points higher among Black patients (p=0.02). The rate of LDA use among white patients increased from 8.0 to 18.3 percent; among Black patients from 11.1 to 30.2 percent. This represents a difference-in-difference of 8.8 percentage points (95% CI 7.6-16.9 pp, p=0.03). All Black patients delivering in 2022 had a USPSTF recommendation for LDA; the LDA rate in this group was 30.2%.
Conclusion:
New wording from the USPSTF and ACOG in 2021 that emphasized the racial inequities of preeclampsia was associated with an increase in the rate of LDA use in Black patients. However, overall rates of LDA use remain well below recommended.