# The Role of the Urban/Rural Divide and Socioeconomic Factors in the Incidence, Outcomes and Post-partum Care of Hypertensive Disorders of Pregnancy

> **NIH NIH R56** · MAYO CLINIC ROCHESTER · 2024 · $502,069

## Abstract

PROJECT SUMMARY/ABSTRACT
In this proposal, we will quantify disparities in incidence, short- and long-term outcomes, and barriers to post-
partum care in women with hypertensive disorders of pregnancy (HDP) according to various demographic
factors and socioeconomic (SES) status indicators. HDP includes a broad spectrum of subtypes associated
with varying degrees of morbidity. Incidence of HDP and its complications are higher in rural areas and
socioeconomic status (SES) likely plays a moderating effect, but this has not been well-studied due to
challenges in determining individual-level SES. Our overall goal is to develop targeted strategies to improve
the cardiovascular health of women after HDP. This proposal strongly aligns with Goal 1 of the 2019-2023
Trans-NIH Strategic Plan for Women's Health Research "Advancing Science for the Health of Women”, which
aims to understand chronic conditions understudied among women and/or that disproportionately affect
populations of women who are understudied, underrepresented, and underreported in biomedical research –
specifically, women in rural areas and women who have low SES. We will use a novel indicator of SES, the
HOUsing-based Socioeconomic Status (HOUSES) index, which is an objective, scalable, standardized, and
individual-level SES measure that predicts multiple health outcomes. Our hypothesis is that SES may be an
important modifier of risk, with low SES causing a multiplicative increase in HDP incidence and outcomes,
regardless of place of residence.The following 3 aims are proposed to understand the intersection between
rural residence and SES in HDP. The first aim is to determine if SES is a significant moderator in the
relationship between urban/rural status and the incidence of HDP and its subtypes. We will quantify the
incidence of HDP subtypes in a 27-county region of the Upper Midwest, which has a large rural population,
using electronic health record data from 2000 to 2021 and test for interactions between urban/rural status and
SES. The second aim is to determine if SES is a significant moderator in the association between urban/rural
status and the risk of short and long-term complications of HDP. Using HDP cases identified in the first aim, we
will identify any cardiovascular and cardiometabolic diagnoses that develop after delivery and characterize
acute care and post-partum visits in the first year after delivery. We will test for interaction between rural/urban
status and SES and conduct a comprehensive cost analysis. The third aim will be to assess key barriers to
care for high-risk women with HDP complications through qualitative semi-structured interviews. We will
interview 30 demographically diverse women with adverse outcomes after HDP using the Health Belief Model
to understand barriers and facilitators of access to post-partum care. By combining the results of this
qualitative aim with the results from Aim 1 and 2, we can develop effective interventions that target high-ris...

## Key facts

- **NIH application ID:** 11175767
- **Project number:** 1R56HL173775-01
- **Recipient organization:** MAYO CLINIC ROCHESTER
- **Principal Investigator:** Andrea G Kattah
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $502,069
- **Award type:** 1
- **Project period:** 2024-09-16 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11175767

## Citation

> US National Institutes of Health, RePORTER application 11175767, The Role of the Urban/Rural Divide and Socioeconomic Factors in the Incidence, Outcomes and Post-partum Care of Hypertensive Disorders of Pregnancy (1R56HL173775-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/11175767. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*