The 130th Annual Meeting of APHA

Abstract #43670

Deborah L. Hoffman, MPH¹, Edmund F. Funai, MD¹, Yechiel Friedlander, PhD², and Susan Harlap, MBBS¹. (1) Department of Obstetrics & Gynecology and Kaplan Cancer Center, New York University School of Medicine, 550 First Avenue, Rm. NB 9E2, New York, NY 10016, 212-263-7792, hoffmd03@popmail.med.nyu.edu, (2) Hebrew University, Ein Kerem, POB 12272, Jerusalem, Israel

We studied factors related to total mortality in a cohort of 37,470 mothers who gave birth in Jerusalem in 1964-76 and were followed-up until mid-2000. We focused especially on mortality after pre-eclampsia. This pregnancy complication had been recorded for 1050 mothers (2.8%) and in 1.6% of their births. Its incidence in our population was associated with lower maternal education and lower socioeconomic status (SES, ranked in classes by partner’s occupation). We used Cox proportional hazards models to assess the effects of pre-eclampsia on mortality, test for interactions, and control for the following predictors of mortality: age, low education, absence of paid employment outside the home, and history in any observed birth of diabetes, heart disease, and low birth weight. After a median follow-up of 30.2 years (range 23.5 - 35.5) there were 1916 deaths. Pre-eclampsia was significantly associated with an increase in mortality; relative risk (RR)=2.2, 95% confidence interval=1.8 - 2.6, p<.0001. Effects of pre-eclampsia were compounded by socioeconomic status. Women with pre-eclampsia in SES classes 6 (lowest), 5, 4, and 1-3 (highest) experienced RRs of 3.3 (2.5 - 4.5), 2.7 (1.8 - 4.0), 2.8 (1.9 - 4.0) and 1.7 (1.2 - 2.3) respectively, compared with 1.3 (1.1 - 1.4), 1.2 (1.1 - 1.4), 1.1 (0.93 - 1.2) and 1 (reference group) respectively, in those without pre-eclampsia. These findings suggest that, in addition to genetically determined factors affecting risk for pre-eclampsia and its sequelae, there also exists a major environmental contribution.

Learning Objectives: After viewing this poster presentation, the participant will be able to

• Define pre-eclampsia
• Identify pre-eclampsia as a risk factor for long-term mortality in women
• Describe the compounded effect of pre-eclampsia and socioeconomic status on long-term mortality in the Jerusalem cohort.

Keywords: Social Class, Mortality

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.