Racial and ethnic disparities in severe maternal morbidity and anesthetic techniques for obstetric deliveries: A multi-state analysis, 2007–2014

Tangel, Virginia; Matthews, Kathy C.; Abramovitz, Sharon; White, Robert S.

doi:10.1016/j.jclinane.2020.109821

Cited by 46 publications

(48 citation statements)

References 27 publications

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“…These articles examine the effect of racism in a variety of treatment choices. These treatment choices include various parts of healthcare including maternal and reproductive healthcare [ 203 , 204 ], pediatric care [ 205 ], cardiovascular diseases [ 12 , 95 ], end of life care [ 11 ], medical decisions in the emergency unit [ 61 ], oncology care [ 206 ] and immunotherapy [ 207 ]. In addition, other articles examine pain management [ 13 , 208 – 210 ], HIV prophylaxis [ 211 ], atrial fibrillation treatment and dialysis treatment [ 212 ] and admission rate in an emergency unit [ 196 ].…”

Section: Resultsmentioning

confidence: 99%

“…According to a quantitative study from the USA, Black women are more likely than White women to receive general anesthesia for cesarean delivery and to receive no analgesia for vaginal delivery [ 204 ]. Another study from the USA also shows that Black and Latinx healthcare users have lower rates of admission to the cardiology service compared to White patients [ 12 ].…”

Section: Resultsmentioning

confidence: 99%

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Racism in healthcare: a scoping review

et al. 2022

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Background Racism constitutes a barrier towards achieving equitable healthcare as documented in research showing unequal processes of delivering, accessing, and receiving healthcare across countries and healthcare indicators. This review summarizes studies examining how racism is discussed and produced in the process of delivering, accessing and receiving healthcare across various national contexts. Method The PRISMA guidelines for scoping reviews were followed and databases were searched for peer reviewed empirical articles in English across national contexts. No starting date limitation was applied for this review. The end date was December 1, 2020. The review scoped 213 articles. The results were summarized, coded and thematically categorized in regards to the aim. Results The review yielded the following categories: healthcare users’ experiences of racism in healthcare; healthcare staff’s experiences of racism; healthcare staff’s racial attitudes and beliefs; effects of racism in healthcare on various treatment choices; healthcare staff’s reflections on racism in healthcare and; antiracist training in healthcare. Racialized minorities experience inadequate healthcare and being dismissed in healthcare interactions. Experiences of racism are associated with lack of trust and delay in seeking healthcare. Racialized minority healthcare staff experience racism in their workplace from healthcare users and colleagues and lack of organizational support in managing racism. Research on healthcare staff’s racial attitudes and beliefs demonstrate a range of negative stereotypes regarding racialized minority healthcare users who are viewed as difficult. Research on implicit racial bias illustrates that healthcare staff exhibit racial bias in favor of majority group. Healthcare staff’s racial bias may influence medical decisions negatively. Studies examining healthcare staff’s reflections on racism and antiracist training show that healthcare staff tend to construct healthcare as impartial and that healthcare staff do not readily discuss racism in their workplace. Conclusions The USA dominates the research. It is imperative that research covers other geo-political contexts. Research on racism in healthcare is mainly descriptive, atheoretical, uses racial categories uncritically and tends to ignore racialization processes making it difficult to conceptualize racism. Sociological research on racism could inform research on racism as it theoretically explains racism’s structural embeddedness, which could aid in tackling racism to provide good quality care.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Racism in healthcare: a scoping review

et al. 2022

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“…While one in five Americans is a female who identifies as a minority, racial health disparities are well documented. Tangel et al conducted an analysis using 2007-2014 data from California, Florida, New York, Maryland, and Kentucky from the Agency for Healthcare Research and Quality (AHRQ) [ 11 ]. They showed that after adjusting for socioeconomic status, Black parturients were 44% more likely to receive general anesthesia for cesarean delivery and 45% less likely to receive any analgesia for labor [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Tangel et al conducted an analysis using 2007-2014 data from California, Florida, New York, Maryland, and Kentucky from the Agency for Healthcare Research and Quality (AHRQ) [ 11 ]. They showed that after adjusting for socioeconomic status, Black parturients were 44% more likely to receive general anesthesia for cesarean delivery and 45% less likely to receive any analgesia for labor [ 11 ]. Glance et al used the New York State Perinatal registry and showed that compared with White, Black and Hispanic parturients were 22% and 15% less likely to receive epidural analgesia from 1999 to 2003, respectively [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

An Update on Racial and Ethnic Differences in Neuraxial Anesthesia for Cesarean Delivery

Burton¹,

Canales²,

Du³

et al. 2021

Cureus

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Background Racial and ethnic differences in the use of neuraxial anesthesia compared with general anesthesia are less studied, particularly in obstetrical anesthesia. Here, we aimed to provide an update on the association between race and ethnicity, and the use of neuraxial anesthesia for cesarean delivery in the United States (US). Methods We used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data File 2019. We extracted cases that had a primary surgery defined with Current Procedural Terminology (CPT) code for cesarean delivery (59510, 59514, and 59515) and cesarean after attempted vaginal delivery in parturients with a prior history of cesarean (59618, 59620, and 59622). Multivariable logistic regression was used to report the association of race and ethnicity with primary anesthetic technique. Results There were 12,876 parturients included in the study. Compared with White parturients, Black (adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI): 0.57-0.88, p = 0.001) and American Indian or Alaska Native (aOR = 0.22, 95% CI: 0.12-0.40, p < 0.001) parturients had lower odds of receiving neuraxial compared with general anesthesia. There were no significant differences in the odds of neuraxial anesthesia between non-Hispanic and Hispanic cohorts. Conclusions While we do observe racial differences in anesthetic technique, Hispanic patients did not have significantly lower odds of neuraxial anesthesia. This study highlights the importance of an update to prior studies, as the current study suggests a lack of disparity between non-Hispanic and Hispanic parturients. While the results here are encouraging, a multidisciplinary approach is necessary to further address racial disparities.

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“…17 Furthermore, previous studies have found that different populations, such as women of different races/ethnicities, have differing rates for each indicator of SMM. 18 …”

Section: Discussionmentioning

confidence: 99%

Impact of the Transition from ICD-9-CM to ICD-10-CM on the Rates of Severe Maternal Morbidity in Arkansas: An Analysis of Claims Data

Rezaeiahari

Brown

Ali

2022

Women's Health Reports

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Background: Severe maternal morbidity (SMM) is considered as a near miss for maternal death, therefore it is crucial to identify and prevent SMM. Medical insurance claims can be used to identify SMM. There was a national transition from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) in October 2015. Objective: This study investigates the impact of transition from ICD-9-CM to ICD-10-CM on the rates of SMM in the state of Arkansas using birth certificates linked with insurance claims data in the Arkansas All-Payer Claims Database (APCD). Study Design: Birth certificates between January 1, 2013, and December 31, 2017, were linked to insurance claims data from the APCD. SMM was defined using the algorithm provided by the Centers for Disease Control and Prevention, using ICD-9 codes for births before October 1, 2015, and ICD-10-CM codes for births on or after October 1, 2015. Results: The incidence of SMM increased after transition to the ICD-10-CM system in Arkansas. The relatively higher rate of SMM in ICD-10-CM versus ICD-9-CM was greater in magnitude on the delivery day and throughout the 42-day postpartum period (odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.20–1.42) compared with the rate on the day of delivery (OR: 1.20; 95% CI: 1.06–1.36). When excluding blood transfusions, the higher rate of SMM during the ICD-10 era was even greater both in the delivery day and 42-day postpartum period (OR: 1.66; 95% CI: 1.49–1.85) and on the day of delivery (OR: 1.58; 95% CI: 1.31–1.90).

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Racial and ethnic disparities in severe maternal morbidity and anesthetic techniques for obstetric deliveries: A multi-state analysis, 2007–2014

Cited by 46 publications

References 27 publications

Racism in healthcare: a scoping review

Racism in healthcare: a scoping review

An Update on Racial and Ethnic Differences in Neuraxial Anesthesia for Cesarean Delivery

Impact of the Transition from ICD-9-CM to ICD-10-CM on the Rates of Severe Maternal Morbidity in Arkansas: An Analysis of Claims Data

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