Health Disparities
Association of Discrimination in Medical Settings and Preeclampsia among Pregnant Women in All of Us Study Olivia Kapera* Olivia Kapera Baojiang Chen Jaime P. Almandoz Courtney Byrd-Williams Sarah E. Messiah
Background. Factors contributing to the increasing prevalence of United States maternal mortality are complex and not well understood. While studies have highlighted the impacts of racism and discrimination on well-being and health, to date, no studies have examined how the role of discrimination in maternal mortality varies by race and ethnicity. To address these gaps, we analyzed the association of discrimination and preeclampsia among a racially and ethnically diverse national sample of pregnant women participating in the All of Us study.
Methods. This cross-sectional study analysis of the All of Us program data included 2,303 pregnant women ages 18-to-44 years. Discrimination was measured by proxy using a 7-item survey to assess courtesy, respect, service quality, being treated as competent, acting afraid, being treated as inferior, and being listened to during a healthcare visit. Adjusted logistic regression models generated odd ratios (aOR) of preeclampsia by discrimination in medical settings controlling for race/ethnicity, body mass index (BMI), gestational hypertension, gestational diabetes, and urinary tract infection.
Results. Mean sample age was 36.7 years (SD 5.01). The sample was 67% (n=1466) non-Hispanic White, 52% (n=1191) college graduate or higher, 42% (n=963) with annual income >$75K, and 58% (n=1336) married. Non-Hispanic Black (NHB) women were ~1.8 to 2.1 times more likely to develop preeclampsia if they experienced discrimination in medical settings compared to those who did not report these experiences controlling for other variables (p-value <0.05 for all items).
Conclusion. Findings here show that discrimination in medical settings is associated with increased odds of preeclampsia in NHB women. These results underscore the need for a comprehensive strategy to address these inequities, encompassing reforms in the healthcare system and broader societal shifts to challenge discrimination to eliminate healthcare disparities.