Racial and ethnic disparity in obstetric anaesthesia: a systematic review and meta-analysis.

Introduction: Racial and ethnic disparities in obstetrics persist globally despite improvements in maternal mortality rates and are related to access, experience and outcomes. We aimed to elucidate the racial and ethnic disparity in obstetric analgesia and anaesthesia.

Methods: Databases were searched and we included studies published in the English language conducted in all countries. Search terms included terminology concerning obstetric anaesthesia related to race or ethnicity. Included papers were assessed for risk of bias. Studies were included for detailed review if they described disparities relating to obstetric anaesthesia between two or more racial or ethnic groups.

Results: In total, 1806 abstracts were screened of which 25 articles were included and data from 19 could be pooled for meta-analysis using a random effects model. Outcome measures included disparities in labour neuraxial analgesia utilisation and general anaesthesia use for caesarean delivery. Sixteen observational studies examined labour neuraxial analgesia, representing data from 13,398,421 patients in the USA and UK. Patients categorised as Asian or Black had lower odds of receiving neuraxial analgesia when compared with those from White backgrounds (odds ratios (95%CI) 0.80 (0.65-0.99) and 0.72 (0.61-0.85), respectively). Six studies examined the use of general anaesthesia for caesarean delivery in 2,139,763 patients. Black patients were more likely to receive general anaesthesia compared with White patients (odds ratio (95%CI) 1.60 (1.15-2.22)). Risk of bias assessments showed high or very high risk of bias in 13 of the 25 included studies.

Discussion: Racial and ethnic disparities exist in obstetric anaesthesia. Further research to elucidate causes and ongoing action to minimise them are crucial.