ArticleCirculation. Population health and outcomes2026
Drivers of Black-White Disparities in Hypertension Risk After Pregnancy: Findings From CARDIA.
Article in Circulation. Population health and outcomes, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHypertension is the leading risk factor for cardiovascular disease, with disparities observed by race. Few studies have examined how intersecting social and sex-based biological determinants influence hypertension incidence among parous individuals and across racial groups. The objective of this study was to examine whether female-specific cardiovascular disease risk factors (eg, adverse pregnancy outcomes), individual-level (eg, education), and structural-level (eg, neighborhood) social drivers of health (SDoH), beyond traditional cardiovascular disease risk factors (eg, physical activity), explain the Black-White disparity in hypertension following pregnancy.
methodsParous individuals in CARDIA (Coronary Artery Risk Development in Young Adults), a longitudinal cohort study beginning in 1985 to 1986, without hypertension before their first pregnancy were included. Race was self-reported at enrollment. Blood pressure was measured at each examination, with hypertension incidence defined as the first elevated blood pressure (systolic ≥130 mm Hg or diastolic ≥80 mm Hg) or initiation of antihypertensive medication after baseline. Participant follow-up time began at the next exam following their first live delivery. Cox proportional hazards models with time-varying covariates calculated hazard ratios and 95% CIs. To quantify how much each set of covariates explained the Black-White difference in hypertension risk, the percentage reduction in the race coefficient was calculated following the addition of female-specific cardiovascular disease risk factors and SDoH in multivariable-adjusted regression models.
resultsAmong 1653 participants (29.4±6.1 years), Black women (n=924) had higher hypertension incidence than White women (n=729): 41.4 versus 18.5 per 1000 person-years, respectively; and an earlier median age at onset (42 versus 48 years). Following traditional risk factors, individual-level SDoH explained the largest disparity (7.52%), followed by female-specific factors (2.26%) and structural-level SDoH (1.50%). Black women remained at higher risk after adjustment (hazard ratio, 2.72 [95% CI, 2.17-3.41]).
conclusionsParous Black women face substantially higher hypertension rates than White women, persisting after accounting for traditional risk factors, female-specific risk factors, and SDoH.
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