Hypertensive disorders of pregnancy (HDP) are the leading causes of maternal morbidity and mortality, complicating about 10 % of all pregnancies [1]. In Mexico, the HDP incidence rate reported in 2020 was 115.67 cases per 100,000 women between 10 and 60 years old [2]; and, although the case-fatality rates declined in 2019, HDP were highly lethal (58 deaths per 100,000 cases) [3]. In Latin America (LA) and the Caribbean, the disability-adjusted life years rate caused by these disorders is between 13.62 (Southern LA) and 86.71 (Caribbean), the rate of years lived with disabilities is 2.51 (Tropical LA) to 3.55 (Southern LA), and the rate of years of life lost varied between 10.07 (Southern LA) and 83.24 (Caribbean) [4].

Social determinants of health (SDH) are “the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life” [5]. There are two groups of SDH, structural and intermediate determinants; structural determinants are the factors that generate social stratification and inequalities, as economic, political, and social welfare systems. Meanwhile, intermediate determinants are the circumstances of daily life that establish individual differences in exposure and vulnerability to health compromising factors [6].

Structural determinants have been recognized as drivers of maternal health inequity risk and play an important role in the maternal HDP burden [7]. Women with low education and low household income have a higher risk of developing HDP, mainly gestational hypertension and eclampsia [8], [9], [10]. Furthermore, lack of access to quality care, caused by the inequitable distribution of health facilities, increases the risk of eclampsia [11]; compared to private health insurance, public or no insurance has been associated with the development of preeclampsia and eclampsia [10].

Evidence suggests that temporal variations in the HDP magnitude could be related to changes in country characteristics, policies, and accessibility to health services. For example, the HDP rate has decreased in Brazil, in part, due to the implementation of the Integral Care Program for Women's Health (1984), the Community Health Agent Program (1991), and the Family Health Strategy (1994) [12]. In Mexico, several health policies have aimed at reducing maternal morbidity and mortality in recent years. The current Official Mexican Norm NOM-007-SSA-2016 emphasizes the relevance of early detection of risk factors and patients' risk awareness from the pre-pregnancy stage [13]. The previous version prioritized obstetric emergencies and treatment monitoring during pregnancy and childbirth care [14].

As the Mexican Health System operation through municipalities in health jurisdictions is influenced by temporal changes in the local government priorities, public sector finances, and public health expenditure [15], we aimed to analyze the HDP trends in the 2000–2020 period and the association of HDP trends with social determinants in Mexican municipalities.