Social Determinants of Health as Primary Risk Factors of Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study

Abstract Public health researchers have raised the question of whether social determinants of health (SDOH) are a primary risk driver for hypertensive disorders of pregnancy (HDP), as opposed to clinical factors including race risk. This retrospective cohort study was performed using known demographic and geospatial risk factors to clarify effects of SDOH on HDP to create performance models comparing SDOH with clinical factors including race risk. Of 5156 pregnancies identified, 7.8% were affected by HDP. 54 factors were compared for their ability to distinguish HDP pregnancies; the top six were aspects of housing. In multivariable logistic models, SDOH demonstrated better model performance (66.1%) than clinical factors and race risk combined (63.0%) as measured by area under receiver operator curve (AUROC). The three categories together demonstrated 71.4% model performance. These models suggest that some incidence of HDP currently predicted by clinical factors including race risk may be better explained by SDOH.