Inequities in Inpatient Obstetrics Pain Management and Evaluation: Age, Race, Mental Health, and Obesity

Wang, Heather M; Worly, Brett

doi:10.1007/s10995-023-03602-x

Cited by 2 publications

(2 citation statements)

References 30 publications

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“…21,28,32,40–42 Racial and ethnic disparities in the use of neuraxial analgesia during childbirth and disparities in pain management during the postpartum period have been reported, but their association with racism has not been investigated so far. 4,43–45 In the present study, we found empirical evidence that structural racism is significantly associated with lower use of labor neuraxial analgesia among both non-Hispanic Black and non-Hispanic White people, independently of sociodemographic and clinical characteristics.…”

Section: Discussionsupporting

confidence: 54%

Structural Racism and Use of Labor Neuraxial Analgesia Among Non-Hispanic Black Birthing People

Guglielminotti,

Lee,

Landau

et al. 2024

Obstetrics &Amp; Gynecology

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OBJECTIVE: To assess the association between structural racism and labor neuraxial analgesia use. METHODS: This cross-sectional study analyzed 2017 U.S. natality data for non-Hispanic Black and White birthing people. The exposure was a multidimensional structural racism index measured in the county of the delivery hospital. It was calculated as the mean of three Black–White inequity ratios (ratios for lower education, unemployment, and incarceration in jails) and categorized into terciles, with the third tercile corresponding to high structural racism. The outcome was the labor neuraxial analgesia rate. Adjusted odds ratios and 95% CIs of neuraxial analgesia associated with terciles of the index were estimated with multivariate logistic regression models. Black and White people were compared with the use of an interaction term between race and ethnicity and the racism index. RESULTS: Of the 1,740,716 birth certificates analyzed, 396,303 (22.8%) were for Black people. The labor neuraxial analgesia rate was 77.2% for Black people in the first tercile of the racism index, 74.7% in the second tercile, and 72.4% in the third tercile. For White people, the rates were 80.4%, 78.2%, and 78.2%, respectively. For Black people, compared with the first tercile of the racism index, the second tercile was associated with 18.4% (95% CI, 16.9–19.9%) decreased adjusted odds of receiving neuraxial analgesia and the third tercile with 28.3% (95% CI, 26.9–29.6%) decreased adjusted odds. For White people, the decreases were 13.4% (95% CI, 12.5–14.4%) in the second tercile and 15.6% (95% CI, 14.7–16.5%) in the third tercile. A significant difference in the odds of neuraxial analgesia was observed between Black and White people for the second and third terciles. CONCLUSION: A multidimensional index of structural racism is associated with significantly reduced odds of receiving labor neuraxial analgesia among Black people and, to a lesser extent, White people.

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Section: Discussionsupporting

confidence: 54%

Structural Racism and Use of Labor Neuraxial Analgesia Among Non-Hispanic Black Birthing People

Guglielminotti,

Lee,

Landau

et al. 2024

Obstetrics &Amp; Gynecology

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“…In addition, we note that greater perceived pain was associated with lower Labor Agentry Scale scores, and there is ample literature suggesting that Black birthing individuals experience less optimal control of their intrapartum and postpartum pain. [20][21][22][23] It is possible that accounting for both race and ethnicity and pain in the models weakens the association between Black race and Labor Agentry Scale scores. Last, labor agentry is just one measure of, and not a representation of the totality of, the labor experience.…”

Section: Discussionmentioning

confidence: 99%

Maternal and Delivery Characteristics and Self-Reported Perceived Control During Labor

Mallett

Hill

Doherty

et al. 2023

Obstetrics &Amp; Gynecology

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Inequities in Inpatient Obstetrics Pain Management and Evaluation: Age, Race, Mental Health, and Obesity

Cited by 2 publications

References 30 publications

Structural Racism and Use of Labor Neuraxial Analgesia Among Non-Hispanic Black Birthing People

Structural Racism and Use of Labor Neuraxial Analgesia Among Non-Hispanic Black Birthing People

Maternal and Delivery Characteristics and Self-Reported Perceived Control During Labor

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