Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
Anesth Analg. 2012 Jan;114(1):172-8. doi: 10.1213/ANE.0b013e318239dc7c. Epub 2011 Nov 10.
Racial and ethnic disparities in the treatment of pain have been well documented, and there is evidence of such disparities in neuraxial analgesia use. Our objectives of this study were to analyze racial/ethnic disparities in neuraxial analgesia use, as well as anticipated use, among laboring Hispanic, African-American, and Caucasian women, and to evaluate sociodemographic, clinical, and decision-making predictors of actual and anticipated neuraxial analgesia use among these women.
Laboring women, in a large urban academic hospital, were interviewed using a face-to-face survey to determine individual factors that may influence choice of labor analgesia. After delivery, the type of labor analgesia used was recorded. The primary outcome was use of neuraxial analgesia. Multivariable logistic regression models were estimated to test the likelihood that race and ethnicity were significantly associated with neuraxial analgesia use, anticipated neuraxial analgesia use, and the intrapartum decision to use neuraxial analgesia.
There was a univariate association between race/ethnicity and anticipated as well as actual use of neuraxial analgesia. However, there was no association between race/ethnicity and the intrapartum decision to use neuraxial analgesia. After controlling for confounders, the association between race/ethnicity and actual use of neuraxial analgesia no longer remained significant (adjusted odds ratio: Hispanic versus Caucasian women 0.66, 95% confidence interval [CI]: 0.24 to 1.80; African-American versus Caucasian women 0.93, 95% CI: 0.31 to 2.77). In contrast, Hispanic women were less likely than Caucasian women to anticipate using neuraxial analgesia even after controlling for confounders (adjusted odds ratio 0.40, 95% CI: 0.20 to 0.82).
After controlling for confounding variables, Hispanic women anticipated using neuraxial analgesia at a lower rate than other racial/ethnic groups; however, actual use was similar among groups.
在疼痛治疗方面，种族和民族差异已经得到充分记录，并且在使用神经轴镇痛方面也有证据表明存在这种差异。我们这项研究的目的是分析在使用神经轴镇痛方面，以及在预期使用方面，拉丁裔、非裔美国人和白种人产妇之间的种族/民族差异，并评估社会人口统计学、临床和决策因素对这些女性实际和预期使用神经轴镇痛的预测作用。
在一家大型城市学术医院中，对临产妇女进行面对面调查，以确定可能影响分娩镇痛选择的个体因素。分娩后，记录使用的分娩镇痛类型。主要结果是使用神经轴镇痛。使用多变量逻辑回归模型来检验种族和民族与神经轴镇痛使用、预期神经轴镇痛使用以及产程中使用神经轴镇痛的决策之间存在显著关联的可能性。
种族/民族与预期使用以及实际使用神经轴镇痛之间存在单变量关联。然而，种族/民族与产程中使用神经轴镇痛的决策之间没有关联。在控制混杂因素后，种族/民族与实际使用神经轴镇痛之间的关联不再显著（调整后的优势比：西班牙裔与白种人女性 0.66，95%置信区间[CI]：0.24 至 1.80；非裔美国人与白种人女性 0.93，95% CI：0.31 至 2.77）。相比之下，即使在控制混杂因素后，西班牙裔女性也比白种女性更不可能预期使用神经轴镇痛（调整后的优势比 0.40，95% CI：0.20 至 0.82）。
在控制混杂变量后，西班牙裔女性预期使用神经轴镇痛的比率低于其他种族/民族群体；然而，各群体之间的实际使用情况相似。
