Hypertension Disorders and the 287(g) Policy in Cobb and Gwinnett Counties 公开
Portillo Molina, Eva (Spring 2025)
Abstract
Background: Immigration policies shape diverse contexts among immigrant groups in the United States (US), often placing undocumented individuals at a heightened risk for identification and deportation. Enforcement policies such as the 287(g) program exacerbate health inequities, which often manifest across several life stages, including pregnancy – a period particularly susceptible to sociopolitical stressors. Hispanic/Latine immigrant populations face disproportionate barriers to healthcare and heightened exposure to stress due to immigration enforcement. These factors can increase the risk of hypertensive disorders of pregnancy (HDP), a group of conditions with serious consequences for both maternal and fetal outcomes.
Methods: Using restricted use US natality data from 2016 to 2022, we investigated changes in HDP among Hispanic/Latine immigrant individuals living in the state of Georgia, following the removal of 287(g) immigration policy in Cobb and Gwinnett counties. We employed a difference in difference approach. Parallel trends tests were first conducted to help ensure causal assumptions were met.
Results: A total of 45,788 records were reviewed across the study period. During the pre- and post-policy removal periods, 2,038 Hispanic/Latine individuals experienced hypertension during pregnancy. Gestational hypertension was the most prevalent diagnosis across all groups and time periods (3.2% to 4.4% in control counties and 3.1%, to 5.4% in treatment counties), followed by chronic hypertension (0.7% to 0.9%, and 0.7% to 0.9%) and eclampsia (0.2% to 0.3% and 0.1% to 0.1%). There was an overall increase in the prevalence of HDP from the pre- to post-policy removal period in both the treatment (3.9% to 6.4%) and control (4.1% to 5.6 %) counties. The DID analysis estimated a 0.5 percentage point increase in HDP incidence among Latine pregnant individuals in Cobb and Gwinnett counties post-policy repeal compared to control counties’ trends (0.5 %, 95% CI: -0.7, 1.7). This estimate was not statistically significant.
Conclusions: Despite the removal of immigration policy enforcement through 287(g) agreements in Cobb and Gwinnett counties, the incidence of pregnancy-related hypertension disorders among Hispanic/Latine individuals compared to other Georgia counties was largely unaffected. Future research should examine alternative mechanisms through which reduction in or removal of immigration enforcement may influence pregnancy related outcomes in Hispanic/Latine communities.
Table of Contents
Table of Contents
Chapter I 1
Background 1
Immigration Policy as a Determinant of Health 1
Concern in Pregnant Immigrant Women 3
Importance of Hypertensive Disorders of Pregnancy (HDP) for Maternal Health 5
Burden Overall and Among Latine Immigrants 5
Limitations of Hispanic Health Research 6
Long-term Effects - Cardiometabolic risk 7
Link Between Immigration Policy and HDP 8
287(g) as an Immigration Policy 9
Addressing Gaps in Research on 287(g) Policy and Maternal Health 10
Chapter II 11
Manuscript 11
Introduction 11
Methods 14
Data and Sample 14
Time Unit of Analysis 15
Comparison Groups 16
Exposure 16
Primary Outcome 17
Statistical Analysis 18
Results 19
Discussion 21
Conclusion 27
Chapter III 29
Public Health Implications 29
References 31
Tables and Figures 36
Supplemental Material 40
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