Racial Differences in the Use of Epidural Analgesia for Labor

TLDR

Pain is undertreated in black and Hispanic patients, and the link between race/ethnicity and epidural use in labor is poorly characterized. The authors performed a retrospective cohort study of 81,883 New York State births (1998–2003) using the Perinatal Database, adjusting for clinical, demographic, insurance, and provider factors to assess race/ethnicity differences in epidural use. After adjustment, Hispanic and black women were significantly less likely to receive epidural analgesia than non‑Hispanic white women (adjusted OR 0.85 and 0.78, respectively), and uninsured status further reduced odds, indicating persistent racial disparities in epidural use.

Abstract

Background There is strong evidence that pain is undertreated in black and Hispanic patients. The association between race and ethnicity and the use of epidural analgesia for labor is not well described. Methods Using the New York State Perinatal Database, the authors examined whether race and ethnicity were associated with the likelihood of receiving epidural analgesia for labor after adjusting for clinical characteristics, demographics, insurance coverage, and provider effect. This retrospective cohort study was based on 81,883 women admitted for childbirth between 1998 and 2003. Results Overall, 38.3% of the patients received epidural analgesia for labor. After adjusting for clinical risk factors, socioeconomic status, and provider fixed effects, Hispanic and black patients were less likely than non-Hispanic white patients to receive epidural analgesia: The adjusted odds ratio was 0.85 (95% CI, 0.78-0.93) for white/Hispanic and 0.78 (0.74-0.83) for blacks compared with non-Hispanic whites. Compared with patients with private insurance, patients without insurance were least likely to receive epidural analgesia (adjusted odds ratio, 0.76; 95% CI, 0.64-0.89). Black patients with private insurance had similar rates of epidural use to white/non-Hispanic patients without insurance coverage: The adjusted odds ratio was 0.66 (95% CI, 0.53-0.82) for white/non-Hispanic patients without insurance versus 0.69 (0.57-0.85) for black patients with private insurance. Conclusion Black and Hispanic women in labor are less likely than non-Hispanic white women to receive epidural analgesia. These differences remain after accounting for differences in insurance coverage, provider practice, and clinical characteristics.