title: Racial and ethnic disparities in the provision of epidural analgesia to Georgia Medicaid beneficiaries during labor and delivery.
abstract: OBJECTIVE
  The purpose of this study was to measure racial and ethnic differences in the proportion of Medicaid patients who receive epidural analgesia during labor and delivery.
  
  
  METHODS
  Using 1998 Georgia Medicaid claims data in a standard State Medicaid Research File format, we identified claims for epidural analgesia among all women who had a normal vaginal delivery during 1998.
  
  
  RESULTS
  There were 29,833 women who met our inclusion criteria, of whom 15,936 (53.4%) had epidural analgesia. Epidural analgesia rates were lower for black women (49.5%), Hispanic women (35.3%), and Asian women (48.1%) than for white, non-Hispanic women (59.6%; P<.001). Rural women had lower epidural rates (39.2%) than urban women (62.1%).
  
  
  CONCLUSIONS
  The study subjects all had identical Medicaid insurance and met the same low-income Medicaid eligibility criteria, yet race/ethnicity was still a significant predictor of epidural analgesia after we had controlled for age, rural-urban residence, and availability of anesthesiologists. Further studies are needed to assess perceived benefits, risks, costs, and obstacles to epidural analgesia that are perceived by patients, physicians, nurses, and midwives.
authors.affiliation: National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, USA.
authors.forename: George
authors.initials: G
authors.lastname: Rust
authors.forename: Wendy N
authors.initials: WN
authors.lastname: Nembhard
authors.forename: Michelle
authors.initials: M
authors.lastname: Nichols
authors.forename: Folashade
authors.initials: F
authors.lastname: Omole
authors.forename: Patrick
authors.initials: P
authors.lastname: Minor
authors.forename: Gerrie
authors.initials: G
authors.lastname: Barosso
authors.forename: Robert
authors.initials: R
authors.lastname: Mayberry
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data*; D001213:Asian / Q000706:statistics & numerical data; D036861:Delivery, Obstetric; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005845:Georgia; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007743:Labor, Obstetric; D016015:Logistic Models; D008484:Medicaid / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011247:Pregnancy; D044465:White People / Q000706:statistics & numerical data