County-Level Structural Racism and Racial Disparities in Hypertensive Disorders of Pregnancy in Georgia

Background: Racialized disparities in hypertensive disorders of pregnancy persist, yet the role of interconnected structural determinants has not been fully explored. We evaluated the association between county-level indicators of structural racial discrimination (SRD) and Black-White disparities in HDP in Georgia. Methods: We conducted exploratory factor analysis to identify latent factors of county-level SRD from 12 indicators representing historic racial violence, criminal justice, residential segregation, and political representation. We linked factor scores to 2020-2024 Georgia natality data and estimated associations between factor scores (tertiles) and Black-White differences in HDP rates. Results: We identified two latent factors: Historic Racism and Racialized Polarization. HDP occurred in 15.5% of 206,438 Black births and 13.1% of 265,693 White births. Compared with the first tertile of Historic Racism factor scores, scores in the second (T2) and third (T3) tertiles were associated with increased Black-White HDP disparities (T2: 6.3, 95% confidence interval [CI]: -3.0-15.5; T3: 5.0, 95% CI: 5.4-15.4). Higher Racialized Polarization scores were associated with increased Black-White HDP disparities (T2: 9.1, 95% CI: -0.3-18.5; T3: 9.8, 95% CI: -1.5-21.2). Conclusions: Structural racism contributes to racial disparities in HDP in Georgia, where historic oppression remains embedded in contemporary legal, political, and social systems.