Loyola University Chicago, Chicago, Illinois, USA.
Mountain Area Health Education Center, Asheville, North Carolina, USA.
Birth. 2023 Sep;50(3):627-635. doi: 10.1111/birt.12717. Epub 2023 Mar 22.
In the United States, there are significant health inequities in perinatal care. This study examined differences in perinatal care provided to women based on the birthing person's designated race, within a large and diverse cohort of women.
This retrospective electronic medical record review identified patients receiving perinatal care within a large hospital system between January 2012 and September 2018 and examined associations between maternal designated race/ethnicity (Hispanic or non-Hispanic [NH] Black, Asian or White) and various provider treatment decisions.
The study sample (N = 7056) was comprised of 36% Hispanic, 34% NH White, 21% NH Black, and 4% NH Asian women, aged 29.7 ± 6.3 years; 53% of the sample had private insurance, and 45% had Medicaid. Few differences by race were seen in perinatal care based on guidelines or expert recommendations (nondiscretionary care). Discretionary care, however, varied by race: Compared with NH White women, NH Black women were less likely to receive a prenatal depression screen (OR 0.8 [95% CI: 0.7, 0.9]) and more likely to have a urine drug test when denying drug use (OR 1.6 [95% CI 1.3, 2.0]), whereas Hispanic (OR 0.6 [95% CI: 0.5, 0.8]) and NH Asian (0.4 [95% CI 0.2, 0.9]) women were less likely to have a urine drug test completed when denying drug use.
Perinatal care differs by maternal race/ethnicity, particularly when guidelines or expert recommendations are absent. Greater efforts need to be made to identify and mitigate providers' implicit and explicit biases; expanded professional guidelines may offer some protections against inequitable, discretionary care.
在美国，围产期护理存在显著的健康不平等现象。本研究在一个大型、多样化的女性队列中，考察了根据分娩人员指定的种族为女性提供围产期护理的差异。
本回顾性电子病历研究于 2012 年 1 月至 2018 年 9 月期间在一家大型医院系统内识别接受围产期护理的患者，并检查了产妇指定种族/民族（西班牙裔或非西班牙裔[NH]黑人、亚裔或白人）与各种提供者治疗决策之间的关联。
研究样本（N=7056）由 36%的西班牙裔、34%的 NH 白人、21%的 NH 黑人以及 4%的 NH 亚裔女性组成，年龄为 29.7±6.3 岁；53%的样本有私人保险，45%有医疗补助。根据指南或专家建议（非酌情护理），种族之间的围产期护理差异很小。然而，酌情护理因种族而异：与 NH 白人女性相比，NH 黑人女性接受产前抑郁筛查的可能性较小（OR 0.8[95%CI：0.7，0.9]），而否认使用药物时更有可能进行尿液药物检测（OR 1.6[95%CI 1.3，2.0]），而西班牙裔（OR 0.6[95%CI：0.5，0.8]）和 NH 亚裔（0.4[95%CI 0.2，0.9]）女性否认使用药物时更不可能进行尿液药物检测。
围产期护理因产妇种族/民族而异，特别是在缺乏指南或专家建议时。需要做出更大的努力来识别和减轻提供者的隐含和明确偏见；扩大专业指南可能为防范不平等、酌情护理提供一些保护。
