Hulchafo Ismael Ibrahim, Scroggins Jihye Kim, Harkins Sarah E, Moen Hans, Tadiello Michele, Cato Kenrick, Davoudi Anahita, Goffman Dena, Aubey Janice James, Green Coretta, Topaz Maxim, Barcelona Veronica
Columbia University School of Nursing, New York, New York.
University of North Carolina at Chapel Hill School of Nursing, Chapel Hill.
JAMA Netw Open. 2025 May 1;8(5):e259599. doi: 10.1001/jamanetworkopen.2025.9599.
Language used in clinical documentation can reflect biases, potentially contributing to health disparities. Understanding associations between patient race and ethnicity and documentation of stigmatizing and positive language in clinical notes is crucial for addressing health disparities and improving patient care.
To examine associations of race and ethnicity with stigmatizing and positive language documentation in clinical notes from hospital birth admission.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included birthing patients at 2 metropolitan hospitals in the Northeastern US between 2017 and 2019. Eligible participants were admitted for labor and birth and had at least 1 free-text clinical note. Analysis was conducted using natural language processing. Data were analyzed between March and December 2024.
Patient race and ethnicity, categorized into mutually exclusive groups of Asian or Pacific Islander, Black, Hispanic, and White.
Presence of 4 stigmatizing language categories (marginalized language or identities, difficult patient, unilateral or authoritarian decisions, and questioning patient credibility) and 2 positive language categories (preferred and/or autonomy, power and/or privilege).
Among the 18 646 patients included in the study (mean [SD] age, 30.5 [6.2] years), 2121 were Black (11.4%), 11 078 were Hispanic (59.4%), and 4270 were White (22.9%). The majority (10 559 patients [56.6%]) were insured by Medicaid. Compared with White patients, Black patients had higher odds of having any stigmatizing language (model 2: odds ratio [OR], 1.25; 95% CI, 1.05-1.49; P < .001), after adjustment for demographic characteristics. Black patients also had higher odds of any positive language documented (model 2: OR, 1.18; 95% CI, 1.05-1.32; P = .006). Hispanic patients had lower odds of documented positive language (model 2: OR, 0.90; 95% CI, 0.82-0.99; P = .03). Asian or Pacific Islander patients had lower odds of language documented in the power and/or privilege category (model 2: OR, 0.71; 95% CI, 0.57-0.88; P = .002).
In this cross-sectional study examining clinical notes of 18 646 patients admitted for labor and birth, there were notable disparities in how stigmatizing and positive language was documented across racial and ethnic groups. This underscores the necessity for improving documentation and communication practices to reduce the use of stigmatizing language.
临床文档中使用的语言可能反映出偏见，这有可能导致健康差距。了解患者种族和族裔与临床记录中污名化语言和积极语言之间的关联，对于解决健康差距和改善患者护理至关重要。
研究医院分娩入院临床记录中种族和族裔与污名化语言及积极语言记录之间的关联。
设计、背景和参与者：这项横断面研究纳入了2017年至2019年美国东北部2家城市医院的分娩患者。符合条件的参与者因分娩入院且至少有1份自由文本临床记录。使用自然语言处理进行分析。于2024年3月至12月进行数据分析。
患者种族和族裔，分为亚洲或太平洋岛民、黑人、西班牙裔和白人这几个相互排斥的组。
存在4种污名化语言类别（边缘化语言或身份、难缠患者、单方面或专制决策以及质疑患者可信度）和2种积极语言类别（偏好和/或自主权、权力和/或特权）。
在纳入研究的18646名患者中（平均[标准差]年龄为30.5[6.2]岁），2121名是黑人（11.4%），11078名是西班牙裔（59.4%），4270名是白人（22.9%）。大多数（10559名患者[56.6%]）由医疗补助计划承保。与白人患者相比，在调整人口统计学特征后，黑人患者出现任何污名化语言的几率更高（模型2：比值比[OR]，1.25；95%置信区间，1.05 - 1.49；P < 0.001）。黑人患者被记录有任何积极语言的几率也更高（模型2：OR，1.18；95%置信区间，1.05 - 1.32；P = 0.006）。西班牙裔患者被记录有积极语言的几率较低（模型2：OR，0.90；95%置信区间，0.82 - 0.99；P = 0.03）。亚洲或太平洋岛民患者在权力和/或特权类别中被记录有语言的几率较低（模型2：OR，0.71；95%置信区间，0.57 - 0.88；P = 0.002）。
在这项对18646名因分娩入院患者的临床记录进行检查的横断面研究中，不同种族和族裔群体在污名化语言和积极语言的记录方式上存在显著差异。这凸显了改善文档记录和沟通实践以减少污名化语言使用的必要性。
