JACC. Advances · 2026
Association of Hypertension With Health Care Access and Utilization Following Childbirth: Differences by Race and Ethnicity.
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Attanasio Laura B, Evans Linnea, Kovell Lara, Geissler Kimberley H
Аннотация
BACKGROUND: Hypertensive disorders of pregnancy raise long-term cardiovascular risk, but little is known about health care access and preventive utilization in the years postpartum.
OBJECTIVES: The objective of the study was to examine health care access and utilization in the 5 years following childbirth by hypertension status and race and ethnicity.
METHODS: We conducted a cross-sectional analysis of 2021 and 2023 Behavioral Risk Factor Surveillance System data. We included women with 1 child under age 5. Exposure categories were no hypertension, pregnancy-only hypertension, and hypertension. Outcomes were having a personal health care provider, foregoing care due to affordability in the past year, past-year checkup, and past-year cholesterol test. We used multivariable logistic regression, adding interaction terms to assess variation by race and ethnicity.
RESULTS: The analytic sample represented a weighted population of 3,175,662. Compared with no hypertension, individuals with hypertension had a 9.0 percentage-point (pp) higher predicted probability of having a personal doctor (95% CI: 2.9-15.2 pp) and a 19.8 pp higher probability of a past-year cholesterol check (95% CI: 9.8-29.8 pp). Pregnancy-only hypertension did not differ from no hypertension for any outcome. In models with interaction terms, hypertension (vs no hypertension) was associated with a higher probability of having a personal doctor and past-year cholesterol for White and Black respondents but not for Hispanic respondents. Hypertension was associated with higher probability of past-year checkup among White women only.
CONCLUSIONS: Pregnancy-only hypertension was not linked to increased preventive care utilization, indicating missed opportunities to connect people with hypertensive disorders of pregnancy history to sustained cardiovascular disease prevention.
OBJECTIVES: The objective of the study was to examine health care access and utilization in the 5 years following childbirth by hypertension status and race and ethnicity.
METHODS: We conducted a cross-sectional analysis of 2021 and 2023 Behavioral Risk Factor Surveillance System data. We included women with 1 child under age 5. Exposure categories were no hypertension, pregnancy-only hypertension, and hypertension. Outcomes were having a personal health care provider, foregoing care due to affordability in the past year, past-year checkup, and past-year cholesterol test. We used multivariable logistic regression, adding interaction terms to assess variation by race and ethnicity.
RESULTS: The analytic sample represented a weighted population of 3,175,662. Compared with no hypertension, individuals with hypertension had a 9.0 percentage-point (pp) higher predicted probability of having a personal doctor (95% CI: 2.9-15.2 pp) and a 19.8 pp higher probability of a past-year cholesterol check (95% CI: 9.8-29.8 pp). Pregnancy-only hypertension did not differ from no hypertension for any outcome. In models with interaction terms, hypertension (vs no hypertension) was associated with a higher probability of having a personal doctor and past-year cholesterol for White and Black respondents but not for Hispanic respondents. Hypertension was associated with higher probability of past-year checkup among White women only.
CONCLUSIONS: Pregnancy-only hypertension was not linked to increased preventive care utilization, indicating missed opportunities to connect people with hypertensive disorders of pregnancy history to sustained cardiovascular disease prevention.