Racial and Economic Segregation Over the Lifecourse and Incident Hypertensive Disorders of Pregnancy among Black Women in California.

Black women in the U.S. have the highest incidence of hypertensive disorders of pregnancy (HDP) and are disproportionately burdened by its adverse sequalae compared to women of all racial and ethnic groups. Segregation, a key driver of structural racism for Black families, can provide critical information to understanding these disparities. We examined the association between racial and economic segregation at two points and incident HDP using intergenerationally linked birth records of 45,204 Black California-born primiparous mothers (born 1982-1997) and their infants (born 1997-2011), with HDP ascertained from hospital discharge records. Women's early childhood and adulthood neighborhoods were categorized as deprived, mixed or privileged based on the Index of Concentration at the Extremes (a measure of concentrated racial and economic segregation) yielding 9 lifecourse trajectories. Women living in deprived neighborhoods at both time points experienced the highest odds of HDP (unadjusted odds ratio from mixed effect logistic regression= 1.26, 95% Confidence Interval= 1.13, 1.40) compared to women living in privileged neighborhoods at both time points. All trajectories involving residence in a deprived neighborhood in early childhood or adulthood were associated with increased odds of HDP, whereas mixed-privileged and privileged-mixed trajectories were not. Future studies should assess the causal nature of these associations.