County-Level Structural Racism and Racial Disparities in Hypertensive Disorders of Pregnancy in Georgia.

BACKGROUND

Racialized disparities in hypertensive disorders of pregnancy persist, yet the role of interconnected structural determinants has not been fully explored. We evaluated the association between county-level indicators of structural racial discrimination (SRD) and Black-White disparities in HDP in Georgia.

METHODS

We conducted exploratory factor analysis to identify latent factors of county-level SRD from 12 indicators representing historic racial violence, criminal justice, residential segregation, and political representation. We linked factor scores to 2020-2024 Georgia natality data and estimated associations between factor scores (tertiles) and Black-White differences in HDP rates.

RESULTS

We identified two latent factors: Historic Racism and Racialized Polarization. HDP occurred in 15.5% of 206,438 Black births and 13.1% of 265,693 White births. Compared with the first tertile of Historic Racism factor scores, scores in the second (T2) and third (T3) tertiles were associated with increased Black-White HDP disparities (T2: 6.3, 95% confidence interval [CI]: -3.0-15.5; T3: 5.0, 95% CI: 5.4-15.4). Higher Racialized Polarization scores were associated with increased Black-White HDP disparities (T2: 9.1, 95% CI: -0.3-18.5; T3: 9.8, 95% CI: -1.5-21.2).

CONCLUSIONS

Structural racism contributes to racial disparities in HDP in Georgia, where historic oppression remains embedded in contemporary legal, political, and social systems.