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Socioeconomic disparities and utilization of anesthetic care during pregnancy and delivery. A French prospective, multicenter, cohort study
Abstract Number: T-03
Abstract Type: Original Research
Socioeconomic disparities and utilization of anesthetic care during pregnancy and delivery. A French prospective, multicenter, cohort study.
Elie Kantor, Jean Guglielminotti, Candice Estellat, for the PreCARE study Group.
Characters with spaces = 2,484 (maximum if table=2,500)
Background: Socioeconomic (SE) disparities during pregnancy are associated with a lower utilization of prenatal care, and with an increased risk of adverse maternal and neonatal outcomes. Pre-anesthetic evaluation (PAE) during pregnancy aims to improve the quality and safety of anesthetic care provided during childbirth, especially neuraxial analgesic techniques (NAT) (Anesthesiol Res Pract 2010;2010). PAE and NAT are free of charge in France, and PAE is mandatory for all women during the last trimester of pregnancy. For patients without a health insurance, a temporary insurance is provided by the French state. This study aims to examine the association between maternal SE disparities and (i) the absence of PAE during pregnancy, and (ii) the non-utilization of NAT during labor.
Methods: Data came from a prospective cohort of 10,419 women who delivered in 4 academic public hospitals in Paris, France. Pre-anesthetic evaluation was defined absent if performed less than 48 hours before delivery; in France, a minimum delay of 48 hours is required before PAE and a planned surgical procedure. Multivariable logistic regression was used to examine the association between maternal SE characteristics (social isolation, poor housing condition, not work-related household income, or absence of a permanent health insurance), immigration characteristics (country of birth), low education level, substances abuse during pregnancy, and language barrier with the absence of PAE, and the non-utilization of NAT.
Results: PAE was absent in 482 (5.6%) of the 8,624 women analyzed. After multivariate adjustment, three risk factors for the absence of PAE were identified: absence of permanent health care insurance (adjusted odds ratio (aOR): 1.23; 95% confidence interval (CI): 1.10-1.37), low education level (aOR: 1.18; 95% CI: 1.06-1.32), and substances abuses (aOR: 1.67; 95% CI: 1.15-2.42]). NAT during labor was not utilized in 776 of the 6,834 women analyzed (8.4%). The only SE characteristic associated with the non-utilization of NAT was a low education level (aOR 1.28; 95% CI: 1.17-1.41).
Conclusions: SE disparities in a healthcare system providing charge-free anesthetic care are associated with an increased risk of the absence of PAE during pregnancy and non-utilization of NAT during labor. Interventions should be targeted to these populations to increase the realization of PAE during pregnancy and improve the quality and safety of anesthesia care during childbirth.