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No hablo: Language based disparities in anticipated epidural analgesia use
Abstract Number: F-4
Abstract Type: Original Research
Introduction: Racial/ethnic disparities in the use of epidural analgesia for labor pain relief exist, with Hispanic women being less likely than White women to use epidural analgesia. Previous work has shown that anticipated epidural analgesia use predicts epidural analgesia use. It is unknown whether there is a difference in anticipated epidural analgesia use based on primary spoken language.
Methods: In this retrospective cross-sectional study, electronic medical record data on Hispanic nulliparous vaginal deliveries over a 3-year period were extracted. On admission, patients self-identified their ethnicity, primary spoken language, and anticipated analgesic use for labor. Extracted data included age, insurance status, labor type, anticipated, and actual analgesic use. Household income was estimated through geocoding based on zip code. Income was dichotomized into high vs. low at the median income. After initial bivariate analyses, a multivariable logistic regression model of anticipated epidural analgesia use using a P<0.1 for model entry was created.
Results: There were 1424 Hispanic women identified. Spanish-speaking Hispanic women were more likely to be married, not privately insured, younger, and have a lower household income than English-speaking Hispanic women. The rate of anticipated epidural analgesia use was 30% for Spanish-speakers, versus 51% for English-speakers (P<0.001). In univariate analysis, primary language, marital status, insurance, age, and income were all significantly associated with anticipated epidural analgesia use. In multivariable analysis, controlling for the factors listed above, Spanish-speaking women were less likely than English-speaking women to anticipate using epidural analgesia (Table). Women who were uninsured, teenagers, and 20-29 years of age were also less likely to use epidural analgesia.
Conclusions: A disparity in anticipated epidural analgesia use exists based on spoken language, even after controlling for other demographic and clinical factors. In contrast to previous studies, income was not a factor in anticipated epidural analgesia use. Possible explanations for the language-based disparity include communications barriers with providers, cultural factors, and other patient-level factors. Further work is necessary to understand this language-based disparity and ensure that patients are making informed decisions about labor analgesia.
Funding: AHRQ F32HS020122