Abstract 4139369: Estimating PPCM Prevalence in the US Reveals Striking Differences by Race and Ethnicity, Income, and Chronic Comorbidities

Introduction: Peripartum cardiomyopathy (PPCM) is cardiomyopathy of unknown etiology occurring in pregnant people shortly before or following delivery. Cardiovascular diseases are a large contributor to maternal morbidity in the US. We estimated PPCM prevalence to understand its contribution to this burden. Methods: We used National Inpatient Sample (NIS) data, a nationally representative sample of US hospital discharge records, from 2010-2020. We identified PPCM and deliveries among people aged 15-55 years using ICD and DRG codes. We excluded discharges missing age and race or ethnicity (n=512,639), and those with other cardiomyopathy codes (n=1010), leaving 7,820,420 delivery discharges. Using NIS survey weights, we calculated PPCM prevalence by age, race and ethnicity, comorbidities, and neighborhood income and adjusted prevalence ratios (aPR) using Poisson regression. Results: After weighting, our analytic set represented 38,672,513 delivery discharges and 41,182 PPCM cases. The overall PPCM prevalence was 109.4 (95% CI: 106.0-112.7) cases per 100,000 delivery discharges (Figure). Overall, PPCM prevalence remained steady from 2010-2020, but increased with advancing maternal age and decreasing neighborhood income. The prevalence in the lowest income quartile was more than double that of the highest income quartile (aPR: 2.4, 95% CI: 2.2-2.6). Compared to non-Hispanic (NH) White people, NH Black people had the highest prevalence (aPR: 3.7, 95% CI: 3.4-3.9), followed by Native American people (aPR: 1.9, 95% CI: 1.5-2.4). Hispanic and NH Asian people both had an aPR of 0.7 (95% CI: 0.6-0.8). Compared to those with no comorbidities, PPCM prevalence was significantly higher among those with certain comorbidities, notably diabetes (aPR: 5.6, 95% CI: 5.1-6.1) and chronic hypertension (aPR: 17.1, 95% CI: 16.0-18.2). Discussion: PPCM prevalence presents significant racial and ethnic, and economic disparities. The higher PPCM prevalence among those with diabetes and hypertension emphasizes the need to strengthen management of chronic conditions. Intensification of efforts to address root causes of these disparities and to enhance cardiovascular health before and during pregnancy may be needed.