Glance Laurent G, Wissler Richard, Glantz Christopher, Osler Turner M, Mukamel Dana B, Dick Andrew W
University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
Anesthesiology. 2007 Jan;106(1):19-25; discussion 6-8. doi: 10.1097/00000542-200701000-00008.
There is strong evidence that pain is undertreated in black and Hispanic patients. The association between race and ethnicity and the use of epidural analgesia for labor is not well described.
Using the New York State Perinatal Database, the authors examined whether race and ethnicity were associated with the likelihood of receiving epidural analgesia for labor after adjusting for clinical characteristics, demographics, insurance coverage, and provider effect. This retrospective cohort study was based on 81,883 women admitted for childbirth between 1998 and 2003.
Overall, 38.3% of the patients received epidural analgesia for labor. After adjusting for clinical risk factors, socioeconomic status, and provider fixed effects, Hispanic and black patients were less likely than non-Hispanic white patients to receive epidural analgesia: The adjusted odds ratio was 0.85 (95% CI, 0.78-0.93) for white/Hispanic and 0.78 (0.74-0.83) for blacks compared with non-Hispanic whites. Compared with patients with private insurance, patients without insurance were least likely to receive epidural analgesia (adjusted odds ratio, 0.76; 95% CI, 0.64-0.89). Black patients with private insurance had similar rates of epidural use to white/non-Hispanic patients without insurance coverage: The adjusted odds ratio was 0.66 (95% CI, 0.53-0.82) for white/non-Hispanic patients without insurance versus 0.69 (0.57-0.85) for black patients with private insurance.
Black and Hispanic women in labor are less likely than non-Hispanic white women to receive epidural analgesia. These differences remain after accounting for differences in insurance coverage, provider practice, and clinical characteristics.
有充分证据表明，黑人及西班牙裔患者的疼痛治疗不足。种族和族裔与分娩时使用硬膜外镇痛之间的关联尚未得到充分描述。
作者利用纽约州围产期数据库，在对临床特征、人口统计学、保险覆盖情况和医疗服务提供者效应进行调整后，研究种族和族裔与分娩时接受硬膜外镇痛可能性之间的关联。这项回顾性队列研究基于1998年至2003年间入院分娩的81883名女性。
总体而言，38.3%的患者分娩时接受了硬膜外镇痛。在对临床风险因素、社会经济状况和医疗服务提供者固定效应进行调整后，西班牙裔和黑人患者比非西班牙裔白人患者接受硬膜外镇痛的可能性更小：与非西班牙裔白人相比，白人/西班牙裔的调整后比值比为0.85（95%CI，0.78 - 0.93），黑人为0.78（0.74 - 0.83）。与有私人保险的患者相比，没有保险的患者接受硬膜外镇痛的可能性最小（调整后比值比，0.76；95%CI，0.64 - 0.89）。有私人保险的黑人患者硬膜外使用比例与没有保险覆盖的白人/非西班牙裔患者相似：没有保险的白人/非西班牙裔患者调整后比值比为0.66（95%CI，0.53 - 0.82），有私人保险的黑人患者为0.69（0.57 - 0.85）。
分娩中的黑人及西班牙裔女性比非西班牙裔白人女性接受硬膜外镇痛的可能性更小。在考虑保险覆盖、医疗服务提供者做法和临床特征差异后，这些差异仍然存在。
