Increased Risk for Mortality Due to Pregnancy-Associated Stroke in Black Women

Pregnant African American woman holding her stomach in hospital
At the 2021 International Stroke Conference, study researchers presented their findings regarding racial disparities in mortality due to pregnancy associated stroke.

In-hospital mortality due to pregnancy-associated stroke (PAS) was elevated among Black women, according to study findings presented at the International Stroke Conference, held remotely from March 17 to 19 2021.

Study researchers from the Cleveland Clinic analyzed data collected between 2002 and 2017 in the United States by the Nationwide Inpatient Sample. Pregnant and postpartum women (N=38,797,752) were assessed for instance of PAS and associated mortality on the basis of race.

Within the study cohort, 21.9% were Black and 0.03% (n=10,959) had PAS.

Despite the fact that Black women made up about a fifth of the entire cohort, more than a third of the women who had a PAS event (41.3%; n=4521) were Black. Stratified by race, the in-hospital mortality rates from PAS were 7.8% among Black women and 5.0% among White women (P <.001).

Stratified by age and race, compared with White women of the same ages, Black women who were between 18 and 24 years old had elevated mortality (adjusted odds ratio [aOR], 2.10; 95% CI, 1.88-2.35; P <.001). The risk for mortality increased for those who were 25 to 29 years old (aOR, 2.75; 95% CI, 2.46-3.07; P <.001) and 30 to 34 years old (aOR, 3.94; 95% CI, 3.50-4.43; P <.001). At ages 35 to 40 years, risk for in-hospital mortality from PAS among Black women began to decrease (aOR, 3.73; 95% CI, 3.25-4.29; P <.001). Risk was lowest among Black women who were greater than 40 years old (aOR, 1.27; 95% CI, 1.08-1.51; P =.005).

Socioeconomic status appeared to be a significant contributing factor to mortality among Black women. Black women in the lowest income quartile had lower risk (aOR, 1.91; 95% CI, 1.74-2.10) than those in the highest quartile (aOR, 2.38; 95% CI, 2.02-2.80) compared with their White counterparts.

These findings indicated increased risk for PAS and associated in-hospital mortality in Black women compared with White women. Age and socioeconomic features were contributing factors to the patterns observed. Study researchers added, “[t]argeted interventions are needed to minimize these observed racial differences.”


Gad MM, Abdeldayem J, Abdelfattah OM, Saad AM, Mahmoud AM, Elgendy IY. Racial Disparities in Pregnancy-Associated Stroke, A US Nationwide Cohort Study. Presented at: International Stroke Conference; March 17-19, 2021. Presentation P869.