title: Racial and Ethnic Disparities in Mode of Anesthesia for Cesarean Delivery.
abstract: BACKGROUND
  Racial and ethnic disparities have been identified in the provision of neuraxial labor analgesia. These disparities may exist in other key aspects of obstetric anesthesia care. We sought to determine whether racial/ethnic disparities exist in mode of anesthesia for cesarean delivery (CD).
  
  
  METHODS
  Women who underwent CD between 1999 and 2002 at 19 different obstetric centers in the United States were identified from the Maternal-Fetal Medicine Units Network Cesarean Registry. Race/ethnicity was categorized as: Caucasian, African American, Hispanic, and Non-Hispanic Others (NHOs). Mode of anesthesia was classified as neuraxial anesthesia (spinal, epidural, or combined spinal-epidural anesthesia) or general anesthesia. To account for obstetric and non-obstetric covariates that may have influenced mode of anesthesia, multiple logistic regression analyses were performed by using sequential sets of covariates.
  
  
  RESULTS
  The study cohort comprised 50,974 women who underwent CD. Rates of general anesthesia among racial/ethnic groups were as follows: 5.2% for Caucasians, 11.3% for African Americans, 5.8% for Hispanics, and 6.6% for NHOs. After adjustment for obstetric and non-obstetric covariates, African Americans had the highest odds of receiving general anesthesia compared with Caucasians (adjusted odds ratio [aOR] = 1.7; 95% confidence interval [CI], 1.5-1.8; P < 0.001). The odds of receiving general anesthesia were also higher among Hispanics (aOR = 1.1; 95% CI, 1.0-1.3; P = 0.02) and NHOs (aOR = 1.2; 95% CI, 1.0-1.4; P = 0.03) compared with Caucasians, respectively. In our sensitivity analysis, we reconstructed the models after excluding women who underwent neuraxial anesthesia before general anesthesia. The adjusted odds of receiving general anesthesia were similar to those in the main analysis: African Americans (aOR = 1.7; 95% CI, 1.5-1.9; P < 0.001); Hispanics (aOR = 1.2; 95% CI, 1.1-1.4; P = 0.006); and NHOs (aOR = 1.2; 95% CI, 1.0-1.5; P = 0.05).
  
  
  CONCLUSIONS
  Based on data from the Cesarean Registry, African American women had the highest odds of undergoing general anesthesia for CD compared with Caucasian women. It is uncertain whether this disparity exists in current obstetric practice.
authors.affiliation: From the *Department of Anesthesia, Stanford University School of Medicine, Stanford, California; †Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California; ‡Department of Health Research Policy, Stanford University School of Medicine, Stanford, California; and §Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Butwick
authors.forename: Yair J
authors.initials: YJ
authors.lastname: Blumenfeld
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Brookfield
authors.forename: Lorene M
authors.initials: LM
authors.lastname: Nelson
authors.forename: Carolyn F
authors.initials: CF
authors.lastname: Weiniger
mesh_terms: D000328:Adult; D001741:Black or African American; D000765:Anesthesia, Conduction / Q000706:statistics & numerical data; D000767:Anesthesia, Epidural / Q000706:statistics & numerical data; D000768:Anesthesia, General / Q000706:statistics & numerical data; D000773:Anesthesia, Obstetrical / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000379:methods / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006801:Humans; D008913:Minority Groups; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012042:Registries; D014481:United States / Q000453:epidemiology; D044465:White People