Introduction
Methods
Data availability
Study population and outcome ascertainment
Data cleaning and preparation
Statistical analysis
Summary statistics
Bivariate and multivariable models
Mapping and temporal trend assessment
Results
Summary statistics
County level average incidence of eHDP (95%CI) | |
---|---|
Maternal age ≥ 35 years old (%) | |
< 2.5 | 10.75 (9.45, 12.00) |
2.5 to 4.2 | 10.15 (9.20, 11.50) |
4.2 to 6.1 | 9.95 (9.00, 11.00) |
> 6.1 | 8.35 (7.70, 9.00) |
Race (Black %) | |
0 | 10.45 (9.30, 11.50) |
0.1-1.7 | 10.05 (8.95, 11.50) |
1.7 to 3.4 | 9.80 (8.70, 11.00) |
3.4 to 6.2 | 10.05 (9.00, 11.50) |
> 6.2 | 8.10 (7.40, 9.00) |
Educational attainment (% completed college) | |
< 18.0 | 9.95 (8.70, 11.50) |
18.0 to 23.4 | 10.55 (9.45, 12.00) |
23.4 to 30.2 | 9.60 (8.60, 10.50) |
> 30.2 | 8.75 (8.10, 9.50) |
Marriage (%) | |
< 43.6 | 8.90 (7.70, 10.50) |
43.6 to 48.6 | 9.70 (8.75, 11.00) |
48.6 to 53.8 | 9.35 (8.50, 10.50) |
> 53.8 | 9.75 (8.90, 10.50) |
Maternal BMI ≥ 30 kg/m2 (%) | |
< 22.6 | 7.95 (7.25, 8.50) |
22.6 to 26.8 | 9.70 (8.80, 10.50) |
26.8 to 31.6 | 10.15 (9.15, 11.50) |
> 31.6 | 11.20 (10.00, 12.50) |
Maternal smoking throughout pregnancy (%) | |
< 13.2 | 8.45 (7.80, 9.00) |
13.2 to 17.8 | 9.80 (8.85, 11.00) |
17.8 to 23.0 | 10.95 (9.85, 12.00) |
> 23.0 | 9.90 (8.70, 11.00) |
Appalachian Region | |
Non-Appalachian | 8.70 (8.15, 9.50) |
Appalachian | 11.10 (10.20, 12.00) |
Year | |
2008 | 8.10 (6.85, 9.50) |
2009 | 8.45 (7.20, 10.00) |
2010 | 9.10 (7.75, 10.50) |
2011 | 8.50 (7.20, 10.00) |
2012 | 9.45 (8.05, 11.00) |
2013 | 10.90 (9.40, 12.50) |
2014 | 9.60 (8.20, 11.50) |
2015 | 10.30 (8.75, 12.00) |
2016 | 10.10 (8.60, 12.00) |
2017 | 10.45 (8.90, 12.50) |
Bivariate and multivariate models
RR (95%CI) | p-value | aRR (95%CI) | p-value | |
---|---|---|---|---|
Mother ≥ 35 years old (%) | ||||
< 2.5 | 1.20 (1.00, 1.45) | 0.04 | 1.10 (0.94, 1.32) | 0.24 |
2.5 to 4.2 | 1.23 (1.04, 1.46) | 0.03 | 1.14 (0.98, 1.30) | 0.084 |
4.2 to 6.1 | 1.11 (0.94, 1.31) | 0.03 | 1.00 (0.86, 1.14) | 0.978 |
> 6.1 | Reference | Reference | ||
Race (Black %) | ||||
> 6.1 | 0.77 (0.64, 0.94) | 0.01 | 1.04 (0.86, 1.26) | 0.657 |
3.4 to 6.1 | 0.96 (0.80, 1.15) | 0.69 | 1.18 (1.00, 1.38) | 0.054 |
1.7 to 3.4 | 0.94 (0.77, 1.14) | 0.55 | 1.10 (0.94, 1.3) | 0.249 |
0.1–1.7 | 0.90 (0.81, 1.14) | 0.69 | 1.02 (0.88, 1.18) | 0.825 |
0 | Reference | Reference | ||
Educational attainment (% completed college) | ||||
> 30.2 | 0.80 (0.73, 1.05) | 0.18 | 1.00 (0.82, 1.22) | 0.969 |
23.4 to 30.2 | 0.95 (0.80, 1.14) | 0.63 | 0.92 (0.78, 1.10) | 0.381 |
18.0 to 23.4 | 1.00 (0.91, 1.22) | 0.43 | 1.00 (0.86, 1.18) | 0.954 |
< 18.0 | Reference | Reference | ||
Marriage (%) | ||||
> 53.8 | 1.10 (0.93, 1.30) | 0.24 | 1.36 (1.14, 1.60) | 0 |
48.6 to 53.8 | 1.05 (0.89, 1.25) | 0.51 | 1.16 (1.00, 1.36) | 0.063 |
43.6 to 48.6 | 1.10 (0.90, 1.34) | 0.34 | 1.18 (1.02, 1.38) | 0.033 |
< 43.6 | Reference | Reference | ||
Maternal BMI ≥ 30 kg/m2 (%) | ||||
> 30.3 | 1.40 (1.17, 1.69) | < 0.01 | 1.26 (1.04, 1.50) | 0.012 |
25.7 to 30.3 | 1.27 (1.08, 1.40) | < 0.01 | 1.12 (0.96, 1.30) | 0.171 |
21.5 to 25.6 | 1.21 (1.04, 1.42) | 0.01 | 1.12 (0.98, 1.30) | 0.105 |
< 21.5 | Reference | Reference | ||
Maternal smoking throughout pregnancy (%) | ||||
> 23.2 | 1.16 (0.97, 1.39) | 0.09 | 1.16 (0.96, 1.42) | 0.12 |
17.9 to 23.2 | 1.29 (1.10, 1.51) | < 0.01 | 1.30 (1.10, 1.54) | 0.003 |
13.2 to 17.8 | 1.10 (0.96, 1.38) | 0.12 | 1.16 (1.00, 1.32) | 5 |
< 13.2 | Reference | Reference | ||
Appalachian Region | ||||
Non-Appalachian | 0.78 (0.68, 0.89) | < 0.01 | 0.86 (0.76, 0.98) | 0.02 |
Appalachian | Reference | Reference | ||
Year | ||||
2017 | 1.30 (1.07, 1.57) | 0.01 | 1.36 (1.10, 1.68) | 3 |
2016 | 1.25 (1.05, 1.49) | 0.01 | 1.40 (1.16, 1.68) | 0 |
2015 | 1.27 (1.05, 1.54) | 0.01 | 1.36 (1.14, 1.62) | 0 |
2014 | 1.19 (0.97, 1.45) | 0.09 | 1.30 (1.06, 1.60) | 0.012 |
2013 | 1.35 (1.10, 1.65) | < 0.01 | 1.48 (1.24, 1.78) | 0 |
2012 | 1.17 (0.93, 1.45) | 0.17 | 1.22 (1.00, 1.50) | 0.045 |
2011 | 1.05 (0.84, 1.31) | 0.64 | 1.10 (0.90, 1.34) | 0.348 |
2010 | 1.13 (0.93, 1.37) | 0.22 | 1.20 (1.00, 1.44) | 0.042 |
2009 | 1.04 (0.85, 1.27) | 0.66 | 1.12 (0.92, 1.36) | 0.243 |
2008 | Reference | Reference |
Mapping and temporal trend assessment
Cluster description Counties | Years | In cluster case | pop | Out cluster case | pop | RR | P-value |
---|---|---|---|---|---|
1. Large cluster – Eastern KY: | 2008-2017 | 148 | 1083 | 1784 | 18,339 | 1.54 | 0.03 |
Breathitt, Perry, Knott, Magoffin, Leslie, Owsley, Wolfe, Lee, Clay, Floyd, Morgan, Letcher, and Harlan | |||||
2. Small cluster – Central KY: Madison and Rockastle | 2012 | 18 | 466 | 176 | 20,830 | 3.81 | 0.05 |
Year | eHDP | Married | BMI ≥ 30 kg/m2 | Smoking during pregnancy | Maternal age ≥ 35 years |
---|---|---|---|---|---|
2008 | 7.70 | 504.18 | 223.26 | 185.90 | 43.76 |
2009 | 8.22 | 501.52 | 223.86 | 166.94 | 45.42 |
2010 | 8.70 | 503.92 | 221.08 | 154.48 | 41.96 |
2011 | 8.12 | 499.32 | 230.80 | 151.24 | 45.02 |
2012 | 9.02 | 505.18 | 233.42 | 155.26 | 45.14 |
2013 | 10.72 | 504.74 | 233.38 | 143.10 | 45.80 |
2014 | 9.50 | 513.70 | 243.38 | 128.12 | 47.62 |
2015 | 9.80 | 513.58 | 252.90 | 119.58 | 52.76 |
2016 | 9.78 | 514.00 | 257.04 | 111.30 | 53.22 |
2017 | 9.90 | 521.36 | 270.44 | 99.70 | 55.68 |
AAPC (95%CI) | 2.84 (-4.26, 10.46) | 0.40 (-0.56, 1.36) | 2.20 (0.78, 3.62)‡ | -5.94 (-7.64, -4.20)‡ | 2.90 (-0.28, 6.18)† |