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October 13, 2012
1:00:00 PM - 2:30:00 PM
Room 103B
Spoken Language and Disparities in Labor Epidural Use
Paloma Toledo, M.D.,M.P.H., Cynthia A. Wong, M.D., William A. Grobman, M.D.,M.B.A., Joe Feinglass, Ph.D., Romana Hasnain-Wynia, Ph.D.
Northwestern University, Chicago, Illinois, United States
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. It is unknown whether there is a difference in 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 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 epidural analgesia use was lower for the Spanish-speakers 66% vs. 81% for English-speakers (P<0.001). 96% of the women who wanted epidural analgesia received it. In univariate analysis, primary language, marital status, insurance, age, and income were all significantly associated with epidural analgesia use. In multivariable analysis, controlling for the factors listed above, Spanish-speaking women were less likely than English-speaking women to use epidural analgesia (Table). Women who were uninsured and 16-19 years of age were also less likely to use epidural analgesia.

Conclusions: A disparity in epidural analgesia use exists based on spoken language. As 96% of the patients who wanted epidural analgesia received it, it is unlikely a systems-level issue, suggesting the disparity exists at the patient-level. It is possible that health literacy or communication barriers exist to knowledge or understanding of analgesic options. Alternatively, there could be other cultural or patient level factors contributing to the disparity. Further work is necessary to ensure that patients who do not anticipate using epidural analgesia are making informed decisions and that lack of understanding is not driving this disparity.

Funding: AHRQ F32HS020122
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