title: Primary Spoken Language and Neuraxial Labor Analgesia Use Among Hispanic Medicaid Recipients.
abstract: BACKGROUND
  Hispanic women are less likely than non-Hispanic Caucasian women to use neuraxial labor analgesia. It is unknown whether there is a disparity in anticipated or actual use of neuraxial labor analgesia among Hispanic women based on primary language (English versus Spanish).
  
  
  METHODS
  In this 3-year retrospective, single-institution, cross-sectional study, we extracted electronic medical record data on Hispanic nulliparous with vaginal deliveries who were insured by Medicaid. On admission, patients self-identified their primary language and anticipated analgesic use for labor. Extracted data included age, marital status, labor type, delivery provider (obstetrician or midwife), and anticipated and actual analgesic use. Household income was estimated from census data geocoded by zip code. Multivariable logistic regression models were estimated for anticipated and actual neuraxial analgesia use.
  
  
  RESULTS
  Among 932 Hispanic women, 182 were self-identified as primary Spanish speakers. Spanish-speaking Hispanic women were less likely to anticipate and use neuraxial anesthesia than English-speaking women. After controlling for confounders, there was an association between primary language and anticipated neuraxial analgesia use (adjusted relative risk: Spanish- versus English-speaking women, 0.70; 97.5% confidence interval, 0.53-0.92). Similarly, there was an association between language and neuraxial analgesia use (adjusted relative risk: Spanish- versus English-speaking women 0.88; 97.5% confidence interval, 0.78-0.99). The use of a midwife compared with an obstetrician also decreased the likelihood of both anticipating and using neuraxial analgesia.
  
  
  CONCLUSIONS
  A language-based disparity was found in neuraxial labor analgesia use. It is possible that there are communication barriers in knowledge or understanding of analgesic options. Further research is necessary to determine the cause of this association.
authors.affiliation: From the Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Paloma
authors.initials: P
authors.lastname: Toledo
authors.forename: Stanley T
authors.initials: ST
authors.lastname: Eosakul
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.forename: Joe
authors.initials: J
authors.lastname: Feinglass
authors.forename: Romana
authors.initials: R
authors.lastname: Hasnain-Wynia
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D003144:Communication Barriers; D032882:Comprehension; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D048949:Labor Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D007802:Language; D016014:Linear Models; D016015:Logistic Models; D008484:Medicaid; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult