Social disparity and the use of intrapartum epidural analgesia in a publicly funded health care system.
OBJECTIVE
We sought to examine the difference in use of labor epidural analgesia among women from different neighborhood socioeconomic groups.


METHODS
Neighborhood socioeconomic variables from the 2001 Canadian Census were linked to singleton vaginal births from the Niday perinatal database (2004-2006) in Ontario, Canada. Births were divided into income and education groups by quintiles. Generalized estimating equations were employed to evaluate the association between labor epidural and neighborhood socioeconomic status. Supplementary analysis was conducted after stratifying data by hospital types.


RESULTS
Compared with those from the richest neighborhood, women from the poorest quintile were the least likely to receive labor epidural analgesia (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.58-0.61). The differences were smallest in teaching hospitals (OR, 0.73; 95% CI, 0.67-0.79) and largest in small community hospitals (OR, 0.57; 95% CI, 0.50-0.64). Similar association was found in neighborhood education quintiles.


CONCLUSIONS
The use of labor epidural analgesia is decreased with decreasing neighborhood economic and education levels.
Liu
Ning
N
OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, the Ottawa Hospital, Ottawa, Ontario, Canada.
Wen
Shi Wu
SW
Manual
Douglas G
DG
Katherine
Wendy
W
Bottomley
Jim
J
Walker
Mark C
MC
D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D007182:Income; D009864:Ontario; D011247:Pregnancy; D012111:Residence Characteristics; D012923:Social Class; D019472:Universal Health Insurance