Disparities in labor analgesia utilization: Factors influencing patient decision-making
Abstract Number: 107
Abstract Type: Original Research
Introduction: There is evidence that there are racial/ethnic differences in the use of epidural analgesia for labor pain relief; however, the reasons for this disparity have not been described. The purpose of this study was to evaluate the factors that influence decisions regarding management of labor pain in patients of different backgrounds.
Methods: A survey was developed based on existing validated surveys that included domains for socioeconomic status, acculturation, trust, and family cohesiveness. Questions regarding knowledge of labor analgesia were developed. After expert panel review, cognitive interviews were conducted for content validity. The final survey was administered via in-person interviews with laboring parturients who had not yet requested analgesia. Groups were compared using the Kruskal-Wallis statistic. After univariable selection, significant variables were entered into a multivariable logistic regression model to determine predictors of epidural analgesia utilization.
Results: 224 Caucasians, 71 Hispanics, and 53 African-Americans (AA) were interviewed. Caucasian patients were more likely to be married, have a higher level of education, income, and have private health insurance than the other groups (P<0.001). Despite expecting more pain during labor than Caucasian women, Hispanic and AA women were more likely to report that they would not use epidural analgesia. The rate of epidural analgesia utilization was highest in the Caucasian group (P<0.01). Patients reported with equal frequency that providers discussed labor analgesia, however, Caucasian patients were more likely to use prenatal classes and books as sources of information, and were more likely to consult with their family in their decision making (P<0.01). AA patients trusted their physicians less than the other groups (P<0.01). Multivariable analysis indicated that the method of labor analgesia the patient expected to use was a significant predictor of epidural analgesia utilization (OR 42.4, 95% CI 11.2, 159.7), as was consulting with family in decision making (OR 20.6, 95% CI 1.42, 297.9), and higher income (OR 1.4, 95% CI 1.1, 1.8). Women with less trust in physicians were less likely to receive epidural analgesia (OR 0.2, 95% CI 0.1, 0.6).
Discussion: A racial disparity in labor epidural utilization exists and appears related to pre-existing expectations, sources of information, and physician-patient relationships.
Funding:Evergreen Invitational Grants Initiative