Social disparity and the use of intrapartum epidural analgesia in a publicly funded health care system

Liu, Ning; Wen, Shi Wu; Manual, D.G.; Katherine, Wendy; Bottomley, Jim; Walker, Mark

doi:10.1016/j.ajog.2009.10.871

Cited by 38 publications

(32 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Using education level as an indicator of socioeconomic status, we can infer that low socioeconomic status may be associated with lower odds of epidural use. These findings are consistent with a previous study reporting that women from the poorest quintile had a lower likelihood of epidural use than those from the richest quintile (OR = 0.59, 95% CI 0.58, 0.61) [3, 4]. The mechanism for this association is unknown, but may be related to cultural practices or reduced access to resources.…”

Section: Discussionsupporting

confidence: 91%

“…intravenous opioids) [1-3]. Despite these potential risks, rates of epidural use in the United States and other industrialized countries have increased dramatically in recent years [4-6]. Currently, in the United States, approximately 60% of parturients (delivering women) receive epidurals for intrapartum pain relief [3].…”

Section: Introductionmentioning

confidence: 99%

“…Previous US-based studies have identified associations between epidural use and the following variables: socioeconomic status, parity, plurality, labor induction, maternal age, race/ethnicity, insurance status, and urban residence [7-9]. In non-US based studies, several of these variables (including race, socioeconomic status, parity and age) have also been reported to be associated with epidural use [4, 10-12]. Better understanding associations with epidural use may help elucidate disparities in epidural utilization and underscore the clinical importance of epidurals in certain circumstances.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk Factors Associated With Epidural Use

et al. 2012

View full text Add to dashboard Cite

BackgroundIdentify variables associated with intrapartum epidural use.MethodsOdds ratios were calculated to quantify associations between selected variables and epidural use using a population-based case-control study of Washington State birth certificate data from 2009.ResultsNon-Whites had 10 - 45% lower odds of epidural use relative to Whites. Foreign-born women had 25 - 45% lower odds of epidural use compared to their US-born counterparts, except for Asians. Women who smoked or induced labor had higher roughly 2-fold higher odds of epidural use compared with non-smokers or women giving birth spontaneously, respectively. Women without a high school diploma or equivalent had lower odds of epidural use relative to those who graduated. Delivering at perinatal units, rural hospitals, or non-profit hospitals had ~50% lower odds of epidural use compared with secondary/teritiary perinatal units, urban hospitals or for-profit hospitals, respectively. ConclusionSeveral individual and health service-related variables were associated with epidural use. These findings elucidate the clinical relevance of epidural use, and dispariaties in its utilization and in quality of care during delivery.KeywordsEpidural use; Foreign birth; Labor; Racial disparities

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors Associated With Epidural Use

et al. 2012

View full text Add to dashboard Cite

show abstract

“…There also seems to be an increased incidence of preeclampsia in minority women [59,60]. One retrospective cohort study evaluated racial/ethnic differences in pregnancy outcomes for 32,193 singleton births to parturients with gestational diabetes mellitus in California [59]. In that cohort, the prevalence of preeclampsia was higher for Hispanic and African American women than for non-Hispanic White women.…”

Section: Obstetric Disparitiesmentioning

confidence: 99%

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

Toledo¹,

Caballero

2013

Curr Anesthesiol Rep

View full text Add to dashboard Cite

Disparities are prevalent within healthcare. Racial and ethnic disparities have been described in the use of neuraxial labor analgesia, in the prevalence of some obstetric conditions, and in obstetric outcomes. The origins of these disparities are likely to be multi-factorial, with patient, provider, and systems-level contributors. One of the objectives of Healthy People 2020 is to achieve health equity, thus eliminating racial and/or ethnic disparities in care. In this review, we give an overview of disparities in obstetric anesthetic and obstetric care.

show abstract

“…In developing countries, prob lems include cost, cultural and socioeconomic influences, small hospital size, language barri ers, disinterested healthcare policies and lack of skilled staff [83]. In developed countries, labor analgesia is less likely to be accessed by those of low educational achievement, in poverty, part of an ethnic minority, of indigenous status, uninsured or with poor social support [84][85][86]. By improving diversity and service competence within health systems, access to and the quality of labor analgesia can be enhanced.…”

Section: Access and Equity In Labor Analgesiamentioning

confidence: 99%

Analgesia for Childbirth: Modern Insights Into an Age-Old Challenge and the Quest for an Ideal Approach

Tulp

Paech

2013

Pain Manage.

View full text Add to dashboard Cite

It is widely recognized that childbirth may be the most painful experience in a woman's lifetime and that women have a right to relief. There are many options, but the efficacy of only a few is supported by robust evidence. Many influences determine which method of pain relief is chosen, including social and cultural factors, availability, cost and personal preference. Due to human diversity and the differing perspectives of consumers, obstetric care providers and health administrators, there is no such thing as 'an ideal approach'. In resource-rich societies, major advances in parturient safety and outcome flow from technique development and better monitoring. Greater awareness of the negative impact of untreated pain and of the relevance of genetic, cultural and social factors motivates research into better predictive models, novel therapies and optimization of existing methods.

show abstract

Social disparity and the use of intrapartum epidural analgesia in a publicly funded health care system

Cited by 38 publications

References 31 publications

Risk Factors Associated With Epidural Use

Risk Factors Associated With Epidural Use

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

Analgesia for Childbirth: Modern Insights Into an Age-Old Challenge and the Quest for an Ideal Approach

Contact Info

Product

Resources

About