Olaniyan Abisola, Hawk Mary, Mendez Dara D, Albert Steven M, Jarlenski Marian, Chang Judy C
Department of Behavioral and Community Health Sciences, the Department of Epidemiology, and the Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, the Center for Innovative Research on Gender Health Equity, University of Pittsburgh, and the Department of Medicine and the Department of Obstetrics, Gynecology, & Reproductive Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Obstet Gynecol. 2023 Nov 1;142(5):1169-1178. doi: 10.1097/AOG.0000000000005385. Epub 2023 Sep 28.
To measure racial inequities in drug testing among pregnant people during the first prenatal visit based on their drug use disclosure pattern.
We used data from a cohort study of patient-clinician communication patterns regarding substance use in first prenatal visits from February 2011 to August 2014. We assessed racial differences (Black-White) in the receipt of urine toxicology testing, stratifying on patients' drug use disclosure to the clinician.
Among 341 study participants (205 Black [60.1%] and 136 White [39.9%] participants), 70 participants (33 Black [47.1%] and 37 White [52.9%] participants) disclosed drug use, and 271 participants (172 Black [63.5%] and 99 White [36.5%] participants) did not disclose drug use during their first obstetric visit. Of 70 participants who disclosed drug use, 50 (28 Black [56.0%] and 22 White [44.0%] White) had urine drug testing conducted. Black pregnant patients who disclosed drug use were more likely to be tested for drugs than their White counterparts in the adjusted regression analysis (adjusted odds ratio [aOR] 8.9, 95% CI 1.3-58.6). Among the 271 participants who did not disclose drug use, 38 (18 Black [47.4%] and 20 White [52.6%] participants) had urine drug testing conducted. For those who did not disclose drug use, the adjusted model showed no statistically significant differences in urine drug testing by patients' race (aOR 0.7, 95% CI 0.3-1.6).
When pregnant people disclosed drug use, clinicians were more likely to order urine drug testing for Black pregnant people compared with their White counterparts, suggesting clinician racial bias. Current practice patterns and protocols such as urine drug testing in pregnancy care deserve review to identify and mitigate areas of potential clinician discrimination.
根据孕妇在首次产前检查时的药物使用披露模式，衡量孕妇药物检测中的种族不平等情况。
我们使用了一项队列研究的数据，该研究涉及2011年2月至2014年8月首次产前检查中患者与临床医生关于药物使用的沟通模式。我们评估了接受尿液毒理学检测方面的种族差异（黑人-白人），并根据患者向临床医生披露的药物使用情况进行分层。
在341名研究参与者中（205名黑人[60.1%]和136名白人[39.9%]参与者），70名参与者（33名黑人[47.1%]和37名白人[52.9%]参与者）披露了药物使用情况，271名参与者（172名黑人[63.5%]和99名白人[36.5%]参与者）在首次产科检查时未披露药物使用情况。在70名披露药物使用情况的参与者中，50名（28名黑人[56.0%]和22名白人[44.0%]）进行了尿液药物检测。在调整后的回归分析中，披露药物使用情况的黑人孕妇比白人孕妇更有可能接受药物检测（调整后的优势比[aOR]为8.9，95%置信区间为1.3-58.6）。在271名未披露药物使用情况的参与者中，38名（18名黑人[47.4%]和20名白人[52.6%]参与者）进行了尿液药物检测。对于那些未披露药物使用情况的参与者，调整后的模型显示，按患者种族进行尿液药物检测没有统计学上的显著差异（aOR为0.7，95%置信区间为0.3-1.6）。
当孕妇披露药物使用情况时，与白人孕妇相比，临床医生更有可能为黑人孕妇开具尿液药物检测医嘱，这表明存在临床医生的种族偏见。当前的实践模式和方案，如孕期护理中的尿液药物检测，值得审查，以识别和减轻潜在的临床医生歧视领域。
