James Kortney Floyd, Hicks Megan, Choi Kristen R, Tobin Courtney S Thomas
National Clinician Scholars Program, Los Angeles David Geffen School of Medicine, University of California, Los Angeles, California, USA.
School of Social Work, Wayne State University, Detroit, Michigan, USA.
Birth. 2023 Dec;50(4):1018-1024. doi: 10.1111/birt.12755. Epub 2023 Aug 7.
The purpose of this study was to investigate the relationship between discrimination during childbirth hospitalization and postpartum care utilization among Black birthing people in California, United States.
This was a secondary analysis of data from the Listening to Mothers in California survey, a population-based survey of individuals with a singleton hospital-based birth in California in 2016. The primary outcome was number of postpartum care visits. The primary exposures were racial, language, and insurance discrimination. A multiple linear regression model was used to estimate associations between discrimination and postpartum care use, adjusting for sociodemographic covariates.
Black birthing people in the sample had an average of two postpartum visits. Almost 15% of the sample reported one or more forms of discrimination during hospital-based childbirth. In adjusted models, racial discrimination (β = 0.09, 95% CI = 0.04-0.14, p < 0.01) and language discrimination (β = 1.03, 95% CI = 0.98-1.07, p < 0.01) were associated with increased postpartum visits, while insurance discrimination was linked to decreased postpartum visits (β = -0.96, 95% CI = -1.04 to -0.89, p < 0.01).
Among Black birthing people in California, the drivers of postpartum care utilization after childbirth are complex. There are multiple negative drivers (e.g., experiencing racial and language discrimination and unmet needs), barriers (e.g., insurance discrimination), and positive drivers (e.g., clinician type and education) that affect postpartum care utilization among Black birthing people.
本研究旨在调查美国加利福尼亚州黑人分娩者在分娩住院期间所遭受的歧视与产后护理利用之间的关系。
这是对加利福尼亚州倾听母亲心声调查数据的二次分析，该调查是一项基于人群的调查，对象为2016年在加利福尼亚州医院单胎分娩的个体。主要结局是产后护理就诊次数。主要暴露因素为种族、语言和保险歧视。采用多元线性回归模型估计歧视与产后护理利用之间的关联，并对社会人口学协变量进行调整。
样本中的黑人分娩者平均进行了两次产后就诊。近15%的样本报告在住院分娩期间遭受了一种或多种形式的歧视。在调整模型中，种族歧视（β = 0.09，95%置信区间 = 0.04 - 0.14，p < 0.01）和语言歧视（β = 1.03，95%置信区间 = 0.98 - 1.07，p < 0.01）与产后就诊次数增加相关，而保险歧视与产后就诊次数减少相关（β = -0.96，95%置信区间 = -1.04至 -0.89，p < 0.01）。
在加利福尼亚州的黑人分娩者中，产后护理利用的驱动因素较为复杂。存在多种负面驱动因素（如遭受种族和语言歧视以及需求未得到满足）、障碍（如保险歧视）以及正面驱动因素（如临床医生类型和教育程度）影响黑人分娩者的产后护理利用情况。
