A national cohort study to investigate the association between ethnicity and the provision of care in obstetric anaesthesia in England between 2011 and 2021

Abstract

There is evidence that ethnic inequalities exist in maternity care in the UK, but those specifically in relation to UK obstetric anaesthetic care have not been investigated before. Using routine national maternity data for England (Hospital Episode Statistics Admitted Patient Care) collected between March 2011 and February 2021, we investigated ethnic differences in obstetric anaesthetic care. Anaesthetic care was identified using OPCS classification of interventions and procedures codes. Ethnic groups were coded according to the hospital episode statistics classifications. Multivariable negative binominal regression was used to model the relationship between ethnicity and obstetric anaesthesia (general and neuraxial anaesthesia) by calculating adjusted incidence ratios for the following: differences in maternal age; geographical residence; deprivation; admission year; number of previous deliveries; and comorbidities. Women giving birth vaginally and by caesarean section were considered separately. For women undergoing elective caesarean births, after adjustment for available confounders, general anaesthesia was 58% more common in Caribbean (black or black British) women (adjusted incidence ratio [95%CI] 1.58 [1.26-1.97]) and 35% more common in African (black or black British) women (1.35 [1.19-1.52]). For women who had emergency caesarean births, general anaesthesia was 10% more common in Caribbean (black or black British) women (1.10 [1.00-1.21]) than British (white) women. For women giving birth vaginally (excluding assisted vaginal births), Bangladeshi (Asian or Asian British), Pakistani (Asian or Asian British) and Caribbean (black or black British) women were, respectively, 24% (0.76 [0.74-0.78]), 15% (0.85 [0.84-0.87]) and 8% (0.92 [0.89-0.94]) less likely than British (white) women to receive neuraxial anaesthesia. This observational study cannot determine the causes for these disparities, which may include unaccounted confounders. Our findings merit further research to investigate potentially remediable factors such as inequality of access to appropriate obstetric anaesthetic care.

Why anaesthetists should care about postnatal care

“…In England, 59% of women who give birth have had an anaesthetic procedure [38]. Improved delivery of quality intrapartum neuraxial anaesthesia and analgesia may improve postnatal outcomes, but there is a need to address the ethnic disparities in how the care is delivered [38]. Applying the principles of enhanced recovery to all caesarean births may standardise care to improve its quality [39].…”

“…Anaesthetists have an important contribution to make to improving postnatal care. In England, 59% of women who give birth have had an anaesthetic procedure [38]. Improved delivery of quality intrapartum neuraxial anaesthesia and analgesia may improve postnatal outcomes, but there is a need to address the ethnic disparities in how the care is delivered [38].…”

Recent studies on racial disparities in obstetric care in the USA: a reply

“…We thank Tangel and White [1] for their interest in our paper [2]. We acknowledge that our paper unfortunately inadvertently overlooked their study of a New York State database between 2007 and 2014 which was published in 2020, although we had referenced a similar earlier study of a New York State database between 1998 and 2003 by Glance et al.…”

Ethnic inequalities in how care is given, not just in access and outcomes

“…We recently published a study of ethnic inequalities for anaesthetic care provided in maternity services in England between 2011 and 2021 2. We found that for elective caesarean birth, women from black Caribbean groups were 58% more likely to have general anaesthesia (1750 per 100 000 population) compared with white British women (1065 per 100 000 population).…”