title: Social disparity and the use of intrapartum epidural analgesia in a publicly funded health care system.
abstract: 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.
authors.affiliation: OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, the Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Ning
authors.initials: N
authors.lastname: Liu
authors.forename: Shi Wu
authors.initials: SW
authors.lastname: Wen
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manual
authors.forename: Wendy
authors.initials: W
authors.lastname: Katherine
authors.forename: Jim
authors.initials: J
authors.lastname: Bottomley
authors.forename: Mark C
authors.initials: MC
authors.lastname: Walker
mesh_terms: 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