Racial and Ethnic Disparities in Obstetrics and Obstetric Anesthesia in the United States

Toledo, Paloma; Caballero, Jorge A.

doi:10.1007/s40140-013-0035-4

Cited by 7 publications

(4 citation statements)

References 71 publications

(59 reference statements)

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“…There is limited work on additional equity characteristics, but some evidence suggests that racial-ethnic disparities exist in pain management and use of neuraxial anaesthesia, and that both patient and provider factors are involved [23]. Based on these and other findings [24][25][26][27], it is necessary to assess the state of the anesthesia literature for incorporation of equity characteristics in RCTs. This can inform the design, analysis, and reporting of future RCTs as well as meta-analyses of existing trials.…”

Section: Introductionmentioning

confidence: 99%

Sex/gender and additional equity characteristics of providers and patients in perioperative anesthesia trials: a cross-sectional analysis of the literature

Etherington

Boet

2021

Korean J Anesthesiol

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Sex and gender, among other equity-related characteristics, influence process of care and patients' outcomes. Currently, the extent to which these characteristics are considered in the anesthesia literature remains unknown. This study assesses their incorporation in randomized controlled trials (RCTs) on anaesthesia-related interventions, for both patients and healthcare providers. This is a cross-sectional analysis using an existing dataset derived from the anesthesia literature. The dataset originated from a scoping review searching MEDLINE, EMBASE, CINAHL, CENTRAL, and the Cochrane Database of Systematic reviews. RCTs investigating the effect of anesthesia-related interventions on mortality for adults undergoing surgery were included. Equity outcome measures were recorded for both patients and providers and assessed for inclusion in study design, reporting of results, and analysis of intervention effects. Three-hundred sixty-one RCTs (n patients = 144 674) were included. Most RCTs (91%) reported patient sex/gender, with 58% of patients identified as male. There were 139 studies (39%), where 70% or more of the sample was male, compared to just 14 studies (4%), where 70% or more of the sample was female. Only 10 studies (3%) analyzed results by patient sex/gender, with one reporting a significant effect. There was substantial variation in how age was reported, although nearly all studies (98%) reported some measure of age. For healthcare providers, equity-related information was never available. Better consideration of sex/gender and additional health equity parameters for both patients and providers in RCTs is needed to improve evidence quality, and ultimately, patient care and outcome.

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Section: Introductionmentioning

confidence: 99%

Sex/gender and additional equity characteristics of providers and patients in perioperative anesthesia trials: a cross-sectional analysis of the literature

Etherington

Boet

2021

Korean J Anesthesiol

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“…analgesia. 31,32 Patients and obstetric care providers may not be aware of recent advances in neuraxial analgesia and the potential benefits of these advances on maternal outcomes. 33 For example, neuraxial analgesia regimens using low concentrations of local anesthetic are associated with a lower risk of instrumental vaginal delivery compared with older regimens using higher-concentration solutions.…”

Section: Discussionmentioning

confidence: 99%

“…Although we accounted for a number of patient-level factors previously shown to be associated with neuraxial analgesia use, such as race/ethnicity, insurance type, and highest level of education, other patient-level factors may account for some of the variation among states. For example, lower health literacy, cultural and religious beliefs, antenatal participation in childbirth education classes, and patient preferences may influence a patient’s decision to use neuraxial analgesia . Patients and obstetric care providers may not be aware of recent advances in neuraxial analgesia and the potential benefits of these advances on maternal outcomes .…”

Section: Discussionmentioning

confidence: 99%

United States State-Level Variation in the Use of Neuraxial Analgesia During Labor for Pregnant Women

et al. 2018

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Key Points Question Does the prevalence of neuraxial labor analgesia vary across US states? Findings In this population-based, cross-sectional analysis of 2 625 950 pregnant women who underwent labor, Maine had the lowest adjusted neuraxial analgesia prevalence (36.6%) and Nevada the highest (80.1%). The odds of receiving neuraxial analgesia were 1.5-fold higher if the same patient received neuraxial analgesia in a high-use vs a low-use state; and 5.4% of the overall variation in neuraxial analgesia prevalence is explained by US state. Meaning Results of this study suggest that wide variation exists in neuraxial analgesia use across US states, with a small portion of the overall variation explained by US states.

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“…Although we can only speculate about possible etiologic factors for the disparities in our study, possible patient-level and healthcare-related factors include cultural barriers between minority patients and their providers, mistrust, misunderstanding, limited interaction with healthcare systems, limited health literacy, and a lack of knowledge about healthcare services and anesthesia options related to labor and delivery. [28][29][30][31][32] Limited data suggest that minority patients are more likely that Caucasian patients to refuse treatment, however studies reporting these differences are small and patient refusal is unlikely to fully explain all healthcare disparities. 28 Provider-level biases may also be important etiologic factors.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Mode of Anesthesia for Cesarean Delivery

Butwick¹,

Blumenfeld²,

Brookfield³

et al. 2016

Obstetric Anesthesia Digest

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Background-Racial and ethnic disparities have been identified in the provision of neuraxial labor analgesia. These disparities may exist in other key aspects of obstetric anesthesia care. We sought to determine if racial/ethnic disparities exist in mode of anesthesia for cesarean delivery (CD). Methods-Women who underwent CD between 1999 and 2002 at 19 different obstetric centers in the United States were identified from the Maternal-Fetal Medicine Units Network Cesarean Registry. Race/ethnicity was categorized as: Caucasian, African-American, Hispanic, Non-Hispanic Others (NHOs). Mode of anesthesia was classified as neuraxial anesthesia (spinal, epidural or combined spinal-epidural anesthesia) or general anesthesia. To account for obstetric and nonobstetric covariates that may have influenced mode of anesthesia, multiple logistic regression analyses were performed using sequential sets of covariates. Results-The study cohort comprised 50,974 women who underwent CD. Rates of general anesthesia among racial/ethnic groups were: 5.2% for Caucasians, 11.3% for African Americans, 5.8% for Hispanics and 6.6% for NHOs. After adjustment for obstetric and nonobstetric covariates, African Americans had the highest odds of receiving general anesthesia compared to Caucasians (adjusted odds ratio (aOR) = 1.7; 95% CI: 1.5-1.8; P<0.001). The odds of receiving general anesthesia were also higher among Hispanics (aOR = 1.1; 95% CI: 1.0-1.3; P=0.02) and NHOs (aOR = 1.2; 95% CI: 1.0-1.4; P=0.03) compared to Caucasians, respectively. In our sensitivity analysis, we reconstructed the models after excluding women who underwent neuraxial anesthesia prior to general anesthesia. The adjusted odds of receiving general anesthesia were similar to those in the main analysis: African-Americans (aOR=1.

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Racial and Ethnic Disparities in Obstetrics and Obstetric Anesthesia in the United States

Cited by 7 publications

References 71 publications

Sex/gender and additional equity characteristics of providers and patients in perioperative anesthesia trials: a cross-sectional analysis of the literature

Sex/gender and additional equity characteristics of providers and patients in perioperative anesthesia trials: a cross-sectional analysis of the literature

United States State-Level Variation in the Use of Neuraxial Analgesia During Labor for Pregnant Women

Racial and Ethnic Disparities in Mode of Anesthesia for Cesarean Delivery

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