itating neuraxial anesthesia complication associated with significant maternal morbidity if undertreated. In this nationwide study, we examine the racial and ethnic disparities in the inpatient utilization of EBP after obstetric PDPH in the United States. METHODS: In this retrospective observational study, we used the National Inpatient Sample, a nationally representative database of discharge records for inpatient admissions in the United States, from 2016 to 2020. We analyzed delivery hospitalizations of women of childbearing age (15–49 years) diagnosed with PDPH. Adjusting for maternal and hospitalization characteristics as confounders, we used a multilevel mixed-effects logistic regression model to compare the rates of EBP utilization by race and ethnicity. Secondarily, among hospitalizations with an EBP, we examined the association between race and ethnicity and the timing of the EBP procedure. RESULTS: We analyzed 49,300 delivery hospitalizations with a diagnosis of PDPH. An EBP was performed in 24,075 (48.8%; 95% confidence interval [CI], 47.8%–49.9%) of these hospitalizations. EBP was performed in 52.7% (95% CI, 51.3%–54.1%) of White non-Hispanic patients with PDPH. Compared to White non-Hispanic patients, Black non-Hispanic (adjusted odds ratio [aOR] = 0.69; 99% CI, 0.56–0.84), Hispanic (aOR = 0.80, 99% CI, 0.68–0.95), and Asian or Pacific Islander patients (aOR = 0.74, 99% CI, 0.58–0.96) were less likely to receive an EBP. The median (interquartile range [IQR]) time to perform an EBP was 2 (1–3) days after admission, with 90% of EBP procedures completed within 4 days of admission. There was no significant association between race and ethnicity and the timing of EBP placement. CONCLUSIONS: In this nationwide analysis of delivery hospitalizations from 2016 to 2020 in the United States with a diagnosis of PDPH, we identified racial and ethnic disparities in the utilization of EBP. Minoritized patients identified as Black non-Hispanic, Hispanic, or Asian or Pacific Islander were less likely to receive an EBP for the treatment of PDPH compared to White non-Hispanic patients. Suboptimal treatment of PDPH may be associated with adverse long-term outcomes such as postpartum depression, posttraumatic stress disorder, and chronic headaches. Racial and ethnic disparities in EBP utilization should be further investigated to ensure equitable health care delivery....

中文翻译：

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美国产科患者硬膜外血贴使用的种族和民族差异：2016-2020 年全国分析


如果治疗不足，与显着孕产妇发病率相关的椎管内麻醉并发症。在这项全国性研究中，我们检查了美国产科 PDPH 后住院患者使用 EBP 的种族和民族差异。方法： 在这项回顾性观察研究中，我们使用了全国住院样本，这是一个具有全国代表性的 2016 年至 2020 年美国住院患者出院记录数据库。我们分析了被诊断患有 PDPH 的育龄妇女 （15-49 岁） 的分娩住院情况。调整孕产妇和住院特征作为混杂因素，我们使用多级混合效应 logistic 回归模型来比较按种族和民族划分的 EBP 利用率。其次，在因 EBP 住院的患者中，我们检查了种族和民族之间的关联以及 EBP 手术的时间。结果： 我们分析了 49,300 例诊断为 PDPH 的分娩住院病例。在这些住院患者中，有 24,075 例 （48.8%;95% 置信区间 [CI]，47.8%–49.9%） 进行了 EBP。在 52.7% （95% CI， 51.3%–54.1%） 的白人非西班牙裔 PDPH 患者中进行了 EBP。与白人非西班牙裔患者相比，非西班牙裔黑人 （校正比值比 [aOR] = 0.69;99% CI，0.56-0.84）、西班牙裔 （aOR = 0.80,99% CI，0.68-0.95） 和亚洲或太平洋岛民患者 （aOR = 0.74,99% CI，0.58-0.96） 接受 EBP 的可能性较小。执行 EBP 的中位 （四分位距 [IQR]）时间为入院后 2 （1-3） 天，90% 的 EBP 程序在入院后 4 天内完成。种族和民族与 EBP 放置的时间之间没有显着关联。 结论： 在对 2016 年至 2020 年美国诊断为 PDPH 的分娩住院人数的全国性分析中，我们确定了 EBP 利用的种族和民族差异。与非西班牙裔白人患者相比，被确定为非西班牙裔黑人、西班牙裔或亚洲或太平洋岛民的少数族裔患者不太可能接受 EBP 来治疗 PDPH。PDPH 的次优治疗可能与不良的长期结果有关，例如产后抑郁症、创伤后应激障碍和慢性头痛。应进一步调查 EBP 利用方面的种族和民族差异，以确保公平的医疗保健提供。