Literature Evaluation Table (Other (Not Listed) Sample)

Student’s Name: PICO Question: Among laboring patients, are there racial and ethnic disparities in neuraxial labor analgesia and treatment of pain?  Literature Evaluation Table Author(s). (Year). Journal Country of Study Purpose (Aim, Objective) Study Design Dependent Variables Independent Variables Sample Size and Method Subject Characteristics (i.e., age, etc.) Setting Instruments Used/Data Collection Results/Findings Limitations, Implications, Credibility, Risk of Bias, Theory/Framework(s), Additional Comments Brebion, M., Bonnet, M. P., Sauvegrain, P., Saurel-Cubizolles, M. J., Blondel, B., Deneux-Tharaux, C., & Azria, E. (2021). British Journal of Anesthesia France To explore the relationship between maternal immigrant status, based on birth country Human Development Index (HDI) and geographic continental origin, and the use of neuraxial analgesia Retrospective cross-sectional study Neuraxial analgesia use to relive labor pain The timing of neuraxial analgesia administration relative to delivery room admission Maternal immigrant status Maternal characteristics, including age, chronic illnesses, educational level, parity, deprivation index, pregnancy and delivery characteristics, and maternity unit characteristics Sample size: 6070 women Method: Archival data from a sample of immigrant women from the 2016 National Perinatal Survey willing to use neuraxial analgesia during birth, representative of births in France was analyzed statistically Age: >30 years Subjects included women with still or live births weighing not less than 500 grams or at least 22 weeks of gestation. Those who delivered within 15 minutes of admission or outside a hospital, those with medical indications or contraindications for neuraxial analgesia, induced labor, and missing data were excluded. Medical records Standard questionnaire administered by midwives before discharge pertaining to the demographic and social characteristics and variables of labor pain management and prenatal care Maternal characteristics questionnaire completed by the heads of labor and delivery units Categorized either by HDI or geographical origin, immigrant women were significantly older, lowly educated, parous, received subpar antenatal care, and had higher deprivation index compared to native French women. Women of sub-Saharan descent and those from low-HDI regions had various chronic illnesses, high rates of Caesarean delivery, a high deprivation index, and were lowly educated. There were no differences in neuraxial analgesia use between immigrant and native women when based on geographic continental origin. However, notable differences were noted when immigration status was classified by HDI. Women from high HDI regions were more likely to use neuraxial analgesia than those born in France. The timing of neuraxial analgesia did not differ in either case. Strengths: * The availability of data on women with initial preference for neuraxial analgesia that that is rarely present in other studies. * Absence of indication bias by ruling out subjects with neuraxial analgesia indications and contraindications * Cultural homogeneity due to classifying the participants by the HDI * Multidimensional classification of immigrant status Limitations: * Possible selection bias by excluding subjects with substantial language barrier * Difficulty distinguishing between refugees and asylum seekers, who may receive dissimilar care due to financial, language, legal, and administrative barriers * Not a randomized control trial (RCT), and can only indicate correlation rather than causation * High neuraxial analgesia use rates in France compared to other high HDI nations may limit the study’s generalizability and external validity Burton, B. N., Canales, C., Du, A. L., Martin, E. I., Cannesson, M., Gabriel, R. A., & Du, A. (2021). Cureus USA To update the relationship between ethnicity, race, and neuraxial analgesia use for caesarean delivery in the U.S. Retrospective cohort study Anesthesia type: neuraxial versus general 30-day endpoints, including hospital readmission, reoperation, surgical site infection, venous thromboembolism, prolonged length of hospital stay, sepsis, mortality, and intraoperative/postoperative red blood cell transfusion Race and ethnicity Sample size: 12,876 parturient women Method: Subjects were classified into six racial and ethnic cohorts. Data was then analyzed using the chi square and analysis of variance (ANOVA) tests to compare the categorical and continuous variables. The multivariable logistic regression was adjusted for various confounding factors, including age, chronic disease, smoking, and emergency delivery procedures, using the odds ratio Age: >18 years Adults who underwent caesarean section in 2019. 0.54% were American Indian, 0.67% Pacific Islanders, 6% Asian, 10% African American, 13% Hispanic, and 48.7% White. 34% declined to disclose their race. There were significant differences in body mass index (BMI) and chronic diseases between the cohorts. Data was derived from the 2019 American College of Surgeons National Surgical Quality Improvement Program’s Participant Use Data File was 93.3% of the subjects received neuraxial analgesia, albeit significant difference between the racial cohorts. The study also found significant unadjusted difference between races in each of the 30-day endpoints. African Americans and American Indians were less likely to receive neuraxial analgesia compare to Whites. Classified by ethnicity, Hispanic or non-Hispanic the differences were not statistically significant. Blacks, Pacific Islanders, and non-Hispanics were more likely to receive epidural rather than spinal anesthesia compared to Whites Strengths: * Primary data prom patients’ charts * The findings update knowledge on the racial and ethnic inequalities in obstetric anesthesiology Limitations: * The persistence of the reported anesthesia practices and health outcomes could not be ascertained due to data collection timelines. * Shortcoming of retrospective study designs * Potential bias due to non-cooperation by some hospitals to provide accurate and complete data * Incomplete data Implications: The study provides a basis for investigating the potential for provider-driven stereotypes to contribute to the racial inequalities in obstetric anesthesiology Butwick, A. J., Blumenfeld, Y. J., Brookfield, K. F., Nelson, L. M., & Weiniger, C. F. (2016). Anesthesia and Analgesia USA To evaluate the existence of ethnic/racial differences in anesthesia delivery mode (neuraxial vs, general) among women delivering via caesarean section, and to investigate whether these relationships are influenced by maternal and demographic factors, caesarean delivery indications, and obstetric morbidities Retrospective cohort study Mode of anesthesia Primary: Race/ethnicity Covariates: Maternal age Multiple/singleton pregnancy Number of previous caesarean deliveries Emergency caesarean indications Insurance class Gestational age Chronic hypertension Labor induction Sample size: 50,974 women undergoing caesarean section Method: Subjects were categorized into four racial cohorts, including African American, Caucasian, Hispanic, and non-Hispanic, whereas anesthesia mode was categorized into general or neuraxial anesthesia. The correlation between the variables was analyzed using univariate and multivariate analyses. Age: >18 years 21.8% percent of the subjects were African American, 41,4% were Caucasian, 25.5 percent Hispanic, and 5% non-Hispanic. Data from the Caesarean Registry culminating from a previous National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network’s multicenter study involving women who underwent caesarean section between 1999 and 2002 There were significant differences in obstetric, demographic, and perioperative characteristics across the ethnic groups. 2442 women received general anesthesia while 1187 women received either spinal or epidural anesthesia African Americans were more likely to receive general anesthesia compared to Caucasians, but this probability reduced moderately after adjusting for covariates. Racial differences increased in the event of emergency caesarean delivery indication, whereby only African Americans and Hispanics were most likely to receive general anesthesia. All Caucasian subgroups had higher chances of receiving neuraxial analgesia compared to all other ethnicities. Strength: The study supports the extant literature on the prevalence of racial disparities in neuraxial analgesia use in the U.S. Limitations: * The observational study design can only determine associations but not causality * Hospital-level factors could not be accounted for due to the type of data used. * The nonlinearity of logistic regression * Outdated dataset * Missing data * Difficulty determining the accuracy of ethnicity/race classifications * Possible bias due to unmeasured factors related to obstetric anesthesia practice Implications: It highlights the need to improve obstetric anesthesia practices to reduce the risk of maternal mortality and other adverse effects during and after caesarean delivery. Jimenez-Puente, A., Benítez-Parejo, N., Del Diego-Salas, J., Rivas-Ruiz, F., & Maanon-Di Leo, C. (2012). BMC Health Services Research Spain To investigate the disproportionate use of epidural analgesia among immigrant women and other minority groups in Marbella, Southern Spain, and to describe the phenomenon’s components Cross-sectional study Obstetric epidural analgesia use Maternal geographic origin and domicile Neonatal birth weight Maternal age Labor type Delivery mode Sample size: 21,034 deliveries Method...