Racial Disparities in Postpartum Pain Management
Racial Disparities in Postpartum Pain Management
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DOI：
10.1097/aog.0000000000003561
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发表时间：
2019-12-01
影响因子：
7.2
通讯作者：
Yee, Lynn M.
中科院分区：
文献类型：
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作者：
Badreldin, Nevert;Grobman, William A.;Yee, Lynn M.
目的：为了评估妇女产后疼痛评分、住院阿片类药物给药和出院阿片类药物处方的种族和民族差异，我们对2015年12月1日至2016年11月30日在一个高容量三级护理中心的所有分娩进行了回顾性队列研究。如果女性自认为是非西班牙裔白色、非西班牙裔黑人或西班牙裔，年龄至少18岁，并且没有记录的对非甾体类阿片类药物或吗啡过敏，则纳入研究。查询医疗记录的三个结局：1）出院时患者报告的产后疼痛评分（量表为0-10）（二分为小于5或5或更高），2）产后住院期间住院阿片类药物给药（报告为产后每天的吗啡毫克当量[MME]），3）出院时接受阿片类药物处方。使用多变量逻辑回归模型评估这些结果与母亲种族-民族之间的关联，随机效应解释出院医生的聚类。进行了敏感性分析，不同种族和民族的妇女匹配使用的倾向scores.RESULTS：共有9,900产后妇女有资格进行分析。与非西班牙裔白色女性相比，西班牙裔和非西班牙裔黑人女性报告疼痛评分为5或更高的几率明显更大（调整后的比值比[aOR]分别为1.61，95% 1.26-2.06和aOR 2.18，95% 1.63-2.91），但住院MME/d显著减少（校正后的β-5.03，95% CI -6.91至-3.15，校正后的β-3.54，95% CI -5.88至-1.20）。此外，与非西班牙裔白色女性相比，西班牙裔和非西班牙裔黑人女性在出院时接受阿片类药物处方的可能性显著降低（aOR 0.80，95% CI 0.67 - 0.96和aOR 0.78，95% CI 0.62-0.98）。倾向评分分析的结果在很大程度上证实了这些主要分析，除了住院MME/天之间的差异非西班牙裔白色和非西班牙裔黑人women does not reach statistical significance.CONCLUSION：西班牙裔和非西班牙裔黑人妇女的经验差异，在产后疼痛管理的设置，不能解释为感知疼痛少。
OBJECTIVE: To evaluate racial and ethnic differences in women's postpartum pain scores, inpatient opioid administration, and discharge opioid prescriptions.METHODS: We conducted a retrospective cohort study of all deliveries at a single high-volume tertiary care center from December 1, 2015, through November 30, 2016. Women were included if they self-identified as non-Hispanic white, non-Hispanic black, or Hispanic; were at least 18 years of age; and did not have documented allergies to nonsteroidal antiinflammatory drugs or morphine. Medical records were queried for three outcomes: 1) patient-reported postpartum pain score (on a scale of 0-10) at discharge (dichotomized less than 5 or 5 or higher), 2) inpatient opioid dosing during postpartum hospitalization (reported as morphine milligram equivalents [MMEs] per postpartum day), and 3) receipt of an opioid prescription at discharge. The associations between each of these outcomes and maternal race-ethnicity were assessed using multivariable logistic regression models with random effects to account for clustering by discharge physician. A sensitivity analysis was conducted in which women of different race and ethnicity were matched using propensity scores.RESULTS: A total of 9,900 postpartum women were eligible for analysis. Compared with non-Hispanic white women, Hispanic and non-Hispanic black women had significantly greater odds of reporting a pain score of 5 or higher (adjusted odds ratio [aOR] 1.61, 95% 1.26-2.06 and aOR 2.18, 95% 1.63-2.91, respectively) but received significantly fewer inpatient MMEs/d (adjusted beta-5.03, 95% CI -6.91 to -3.15, and adjusted beta-3.54, 95% CI -5.88 to -1.20, respectively). Additionally, Hispanic and non-Hispanic black women were significantly less likely to receive an opioid prescription at discharge (aOR 0.80, 95% CI 0.67 to -0.96 and aOR 0.78, 95% CI 0.62-0.98) compared with non-Hispanic white women. Results of the propensity score analysis largely corroborated those of the primary analysis, with the exception that the difference in inpatient MMEs/d between non-Hispanic white and non-Hispanic black women did not reach statistical significance.CONCLUSION: Hispanic and non-Hispanic black women experience disparities in pain management in the postpartum setting that cannot be explained by less perceived pain.