Increase in ED visits for hypertensive disorders from 2006 to 2020 reported

Increase in ED visits for hypertensive disorders from 2006 to 2020 reported | Image Credit: © Andrey Popov - © Andrey Popov - stock.adobe.com.

A significant increase in emergency department (ED) visits for hypertensive disorders of pregnancy and the postpartum period (HDPP) occurred in the United States between 2006 and 2020, according to a recent study published in JAMA Network Open.¹

HDPP have been attributed to 6.3% of all pregnancy-related mortalities in the United States, as well as being the second leading cause of maternal death worldwide. Among US demographics, Black patient experience the highest rates of pregnancy-related mortality.

According to the American College of Obstetricians and Gynecologists, the risks of conditions such as stroke, seizure, myocardial ischemia, placental abruption, and maternal and neonatal mortality may be mitigated through severe blood pressure management in pregnancy within 30 to 60 minutes of diagnosis. This indicated the ED as a critical environment for HDPP treatment.

To evaluate the use of EDs for HDPP management in the United States, investigators conducted a cross-sectional study. The Nationwide Emergency Department Sample was assessed for HDPP-related ED use between 2006 and 2020 among pregnant or postpartum patients aged 15 to 50 years.

HDPP diagnoses were determined based on International Classification of Diseases, Ninth Revision (ICD-9) or ICD-10 codes, with total annual ED visits for HDPP reported as the primary outcome. Hospital admissions and HDPP-related ED use stratified based on race and ethnicity were reported as secondary outcomes.

Covariates included age, payment method, income quartile by zip code, hospital teaching status, and hospital geographic region. Race and ethnicity data was only available for 2019 and 2020.

There were 656,711 HDPP-related ED encounters from 2006 to 2020, increasing from 31,623 in 2006 to 55,893 in 2020. Additionally, admission for HDPP increased from 17,338 in 2006 to 43,563 in 2020, with admission rates for HDPP at 54.8% and 77.9%, respectively. In comparison, admission rates for all other primary diagnoses remained stable.

The odds of presenting to the ED for HDPP were increased compared to other diagnoses for non-Hispanic Black, Hispanic, and Asian individuals, with rates of 26.7% vs 25.4%, respectively, for non-Hispanic Black, 21.1% vs 17.6%, respectively, for Hispanic, and 4.4% vs 2.1%, respectively, for Asian patients. These individuals were also more likely to be admitted for HDPP than their non-Hispanic White counterparts.

Overall, a significant increase in US ED visits and admissions for HDPP were observed between 2006 and 2020, with ED utilization for HDPP higher among non-Hispanic Black, Hispanic, and Asian individuals. Investigators recommended “accessible, culturally competent community-level interventions for all.”

These results are supported by data from a population-based retrospective study analyzing preeclampsia trends between 2010 and 2021.² The study included nonanomalous live births at 24 to 42 weeks’ gestation, with birth certificate data obtained from the National Vital Statistics System database.

There were 32,752,948 US births included in the final analysis. Between 2010 and 2021, chronic hypertension rates rose from 1.2% to 2.7%, while gestational diabetes rates rose from 0.7% to 1.1% This indicated increases of 1.5% and 0.4%, respectively.

Additionally, advanced maternal age rates increased from 14.7% in 2010 to 20.1% in 2021, while in vitro fertilization rates increased from 0.5% to 1.5%. Overall, a 5% increase in hypertensive disorders of pregnancy was reported, indicating a need for public health factors to reduce modifiable risk factors.

References

1. Townsel C, Louis L, Clark C, et al. Emergency Department Utilization for Hypertensive Disorders of Pregnancy and Post Partum, 2006-2020. JAMA Netw Open. 2024;7(9):e2433045. doi:10.1001/jamanetworkopen.2024.33045
2. Krewson C. Rising prevalence of hypertensive disorders of pregnancy reported. Contemporary OB/GYN. June 10, 2024. Accessed September 18, 2024. https://www.contemporaryobgyn.net/view/rising-prevalence-of-hypertensive-disorders-of-pregnancy-reported