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

Summary

Meta-analysis of large observational datasets shows lower odds of neuraxial labor analgesia among Asian and Black patients versus White patients, and higher odds of general anesthesia for cesarean delivery among Black patients. Findings underscore persistent inequities in obstetric anesthesia access and practice.

Key Findings

• Lower odds of neuraxial labor analgesia for Asian (OR 0.80; 95% CI 0.65–0.99) and Black (OR 0.72; 95% CI 0.61–0.85) patients versus White.
• Higher odds of general anesthesia for cesarean delivery among Black patients versus White (OR 1.60; 95% CI 1.15–2.22).
• Meta-analysis pooled 19 studies (labor neuraxial n=13,398,421; cesarean GA n=2,139,763) using random-effects models.
• Risk of bias high/very high in 13 of 25 included studies, highlighting need for better controlled analyses.

Clinical Implications

Implement targeted QI: standardized counseling for labor neuraxial analgesia, timely access to neuraxial placement, interpreter services, and audit-feedback on anesthesia modality by race/ethnicity. Address structural and implicit bias via training and system redesign.

Limitations

• Predominantly observational data with high risk of bias in many studies
• Residual confounding (socioeconomic status, comorbidities, hospital factors) and heterogeneity in race/ethnicity definitions

Future Directions

Prospective equity-focused cohorts and quasi-experimental interventions (e.g., standardized neuraxial pathways) to reduce disparities; linkage with patient-reported outcomes and satisfaction.