Abstract
Objective
To evaluate disparities of pain management among patients giving birth in inpatient Obstetrics units based on age, race, BMI, and mental health diagnoses.
Methods
A retrospective cohort study was performed and included all individuals giving birth at a tertiary-care institution in 2019. Patient-reported pain scores, and inpatient narcotic administration and dosing for pain control were collected. Models were adjusted for race, age, BMI, and diagnoses of anxiety, depression, opioid use disorder, and/or schizophrenia.
Results
4788 Individuals met the inclusion criteria. A higher proportion of African American patients reported severe pain (n = 233/607, 38.4%) and received narcotics (n = 653/1141, 57.2%) compared to patients of other races. Despite controlling for several possible confounders, African American patients (OR 1.55, 95% CI 1.08–2.22), patients with increased BMI (OR 1.02, 95% CI 1.01–1.03), and patients with a mental health diagnosis (OR 2.33, 95% CI 1.32–4.12) were more likely to have worse pain at rest. Older patients were more likely to be administered narcotics (n = 447/757, 59.0%) compared to younger patients (patients aged 18–26: n = 577/1257, 52.3%; patients aged 27–35: n = 1451/2774, 52.3%; p < 0.001), despite younger patients being more likely to have severe pain (OR 1.50; 95% CI 1.20–1.86; p = 0.001).
Conclusions
Patients who are Non-Hispanic African American and patients with obesity and mental health diagnoses experience inequities in postpartum pain management. Pain is complex and multifactorial and can be impacted by cultural, social, environmental factors and more. Further studies on factors that influence pain perception and management in inpatient obstetrics units are needed.
Significance
Inequities in obstetrical outcomes exist among patients of varying demographics. African American patients and patients with depression or anxiety have higher rates of pregnancy-related morbidity. African American and Hispanic patients more frequently report severe pain, despite receiving less narcotic pain medication.
The relationship of several demographic factors, such as race, age, BMI, and mental health contributes to obstetrical pain management, and should be analyzed together. Postpartum pain has a multifactorial etiology and may be influenced by these contributing demographic factors. Such data could help explain differences seen in postpartum pain management.
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Data Availability
All patient data were obtained via The Ohio State University Wexner Medical Center Information Warehouse database using de-identified health records.
Code Availability
Not applicable.
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Acknowledgements
This work was financially supported in part by The Ohio State University College of Medicine Medical Student Research Program. The sponsor was not involved in the study design, collection, analysis, interpretation of data, writing of the report, or decision to submit the manuscript.
Funding
This work was financially supported in part by The Ohio State University College of Medicine Medical Student Research Program. The sponsor was not involved in the study design, collection, analysis, interpretation of data, writing of the report, or decision to submit the manuscript.
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HW and BW contributed to the design and implementation of the research, to the analysis of the results, and to the writing of the manuscript.
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Wang, H.M., Worly, B.L. Inequities in Inpatient Obstetrics Pain Management and Evaluation: Age, Race, Mental Health, and Obesity. Matern Child Health J 27, 538–547 (2023). https://doi.org/10.1007/s10995-023-03602-x
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DOI: https://doi.org/10.1007/s10995-023-03602-x