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Racial and Ethnic disparities in Mode of Anesthesia for Cesarean Delivery
Abstract Number: S-54
Abstract Type: Original Research
Background: Racial/ethnic disparities have been identified in the anticipated and actual use of neuraxial labor analgesia.(1) These disparities may exist in other key aspects of obstetric anesthesia. We sought to determine if racial/ethnic disparities exist in mode of anesthesia for cesarean delivery (CD).
Methods: Women undergoing cesarean delivery (CD) were identified among a U.S. cesarean registry from a previous MFMU study.(2) Race/ethnicity was categorized as: Caucasian, African-American, Hispanic, Non-Hispanic Others (NHOs). Mode of anesthesia was classified as neuraxial anesthesia (spinal, epidural or combined spinal-epidural anesthesia) or general anesthesia (GA). To account for obstetric/non-obstetric co-variates that may have influenced mode of anesthesia, multiple logistic regression analyses was performed using 4 sequential models:(Model 1) race and ethnicity only; (Model 2) Model 1 covariates + maternal sociodemographic factors;(Model 3) Model 2 covariates + obstetric factors; (Model 4) Model 3 covariates + emergency indications for CD.
Results: The study cohort comprised 50,972 women who underwent CD. Rates of GA among racial/ethnic groups were: 5.2% for Caucasians, 11.3% for African Americans, 5.8% for Hispanics and 6.6% for NHOs. After adjustment for obstetric and non-obstetric covariates, African Americans had the highest odds of receiving GA vs. Caucasians (aOR = 1.7; 95% CI: 1.6 – 1.9). The odds of receiving general anesthesia were also higher among Hispanics (aOR = 1.1; 95% CI: 1.0 – 1.3) and NHOs (aOR = 1.2; 95% CI: 1.0 – 1.5) compared to Caucasians respectively.
Conclusion: Our results suggest that racial/ethnic disparities exist in mode of anesthesia for CD, with African-Americans being at highest risk of GA compared to Caucasians.
References: (1) Curr Anesthesiology Reports 2013:3;292-299. (2) N Engl J Med 2008;359:895-905.