Racial Differences in the Use of Epidural Analgesia for Labor

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Racial Differences in the Use of Epidural Analgesia for Labor
Laurent G. Glance,* Richard Wissler,* Christopher Glantz,† Turner M. Osler,‡ Dana B. Mukamel,§ and Andrew W. Dick∥
(Anesthesiology, 106:19-25, 2007)
Departments of *Anesthesiology and †Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY; ‡Department of Surgery, University of Vermont Medical College, Burlington, VT; §Center for Health Policy Research, University of California, Irvine, CA and ∥RAND Corporation, Pittsburgh, PA.
Strong evidence that pain is undertreated in black and Hispanic patients exists. The association between race and ethnicity and the use of epidural analgesia for labor has not been well described. Using the New York State Perinatal Database, whether race and ethnicity were associated with the likelihood of receiving epidural analgesia for labor was examined after adjusting for clinical characteristics, demographics, insurance coverage, and provider effect. The retrospective cohort study was based on 81,883 women admitted for childbirth between 1998 and 2003. Overall, 38.3% of the patients received epidural analgesia for labor. After adjustment for clinical risk factors, socioeconomic status, and provider fixed effects, Hispanic and black patients were less likely than non-Hispanic white patients to receive epidural analgesia. The adjusted odds ratio was 0.85 (95% confidence interval [CI], 0.78-0.93] for white/Hispanic patients and 0.78 (95% CI, 0.74-0.83) for blacks compared with non-Hispanic whites. When compared with patients with private insurance, patients without insurance were least likely to receive epidural analgesia (adjusted odds ratio 0.76; 95% CI, 0.64-0.89). Black patients with private insurance had similar rates of epidural use to white/non-Hispanic patients without insurance coverage: The adjusted odds ratio was 0.66 (95% CI, 0.53-0.82) for white/non-Hispanic patients without insurance versus 0.69 (95% CI, 0.57-0.85) for black patients with private insurance. It was concluded that black and Hispanic women in labor are less likely than non-Hispanic white women to receive epidural analgesia. The disparities remain after adjusting for differences in insurance coverage, provider practice, and clinical characteristics.

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