Racial differences in the use of epidural analgesia for labor.
BACKGROUND
There is strong evidence that pain is undertreated in black and Hispanic patients. The association between race and ethnicity and the use of epidural analgesia for labor is not well described.


METHODS
Using the New York State Perinatal Database, the authors examined whether race and ethnicity were associated with the likelihood of receiving epidural analgesia for labor after adjusting for clinical characteristics, demographics, insurance coverage, and provider effect. This retrospective cohort study was based on 81,883 women admitted for childbirth between 1998 and 2003.


RESULTS
Overall, 38.3% of the patients received epidural analgesia for labor. After adjusting for clinical risk factors, socioeconomic status, and provider fixed effects, Hispanic and black patients were less likely than non-Hispanic white patients to receive epidural analgesia: The adjusted odds ratio was 0.85 (95% CI, 0.78-0.93) for white/Hispanic and 0.78 (0.74-0.83) for blacks compared with non-Hispanic whites. Compared with patients with private insurance, patients without insurance were least likely to receive epidural analgesia (adjusted odds ratio, 0.76; 95% CI, 0.64-0.89). Black patients with private insurance had similar rates of epidural use to white/non-Hispanic patients without insurance coverage: The adjusted odds ratio was 0.66 (95% CI, 0.53-0.82) for white/non-Hispanic patients without insurance versus 0.69 (0.57-0.85) for black patients with private insurance.


CONCLUSIONS
Black and Hispanic women in labor are less likely than non-Hispanic white women to receive epidural analgesia. These differences remain after accounting for differences in insurance coverage, provider practice, and clinical characteristics.
Glance
Laurent G
LG
University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA. laurent_glance@urmc.rochester.edu
Wissler
Richard
R
Glantz
Christopher
C
Osler
Turner M
TM
Mukamel
Dana B
DB
Dick
Andrew W
AW
D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data*; D044466:Asian People / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015999:Multivariate Analysis; D011247:Pregnancy; D044469:Racial Groups / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data