title: Ethnic differences in the use of intrapartum epidural analgesia.
abstract: BACKGROUND
  Obstetric epidural analgesia (EA) is widely applied, but studies have reported that its use may be less extensive among immigrant women or those from minority ethnic groups. Our aim was to examine whether this was the case in our geographic area, which contains an important immigrant population, and if so, to describe the different components of this phenomenon.
  
  
  METHODS
  Cross-sectional observational study.
  
  
  METHODS
  general acute care hospital, located in Marbella, southern Spain. Analysis of computer records of deliveries performed from 2004 to 2010. Comparison of characteristics of deliveries according to the mothers' geographic origins and of vaginal deliveries noting whether EA was received, using univariate and bivariate statistical analysis and multiple logistic regression (MLR).
  
  
  RESULTS
  A total of 21,034 deliveries were recorded, and 37.4% of these corresponded to immigrant women. EA was provided to 61.1% of the Spanish women and to 51.5% of the immigrants, with important variations according to geographic origin: over 52% of women from other European countries and South America received EA, compared with around 45% of the African women and 37% of the Asian women. These differences persisted in the MLR model after adjusting for the mother's age, type of labor initiation, the weight of the neonate and for single or multiple gestation. With the Spanish patients as the reference category, all the other countries of origin presented lower probabilities of EA use. This was particularly apparent for the patients from Asia (OR 0.38; 95%CI 0.31-0.46), Morocco (OR 0.49; 95%CI 0.43-0.54) and other Africa (OR 0.55; 95%CI 0.37-0.81).
  
  
  CONCLUSIONS
  We observed a different use of EA in vaginal deliveries, according to the geographic origin of the women. The explanation for this involves a complex set of factors, depending both on the patient and on the healthcare staff.
authors: Evaluation Unit, Hospital Costa del Sol, Marbella, Spain. ajpuente@hcs.es
authors: Alberto
authors: A
authors: Jiménez-Puente
authors: Nicolás
authors: N
authors: Benítez-Parejo
authors: Jorge
authors: J
authors: Del Diego-Salas
authors: Francisco
authors: F
authors: Rivas-Ruiz
authors: Claudio
authors: C
authors: Maañón-Di Leo
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016362:Analgesia, Obstetrical / Q000379:methods; D001208:Asia / Q000208:ethnology; D002391:Catchment Area, Health / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005060:Europe / Q000208:ethnology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007743:Labor, Obstetric / Q000208:ethnology*; D016347:Medical Records Systems, Computerized; D018743:Perinatal Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology; D011272:Pregnancy, Multiple / Q000208:ethnology / Q000706:statistics & numerical data; D036301:Qualitative Research; D012307:Risk Factors; D012959:Socioeconomic Factors; D013020:South America / Q000208:ethnology; D013030:Spain