Neuraxial labor analgesia use among racial and ethnic groups in the United States, 2016–2022

Abstract Introduction Neuraxial analgesia is the most effective modality for pain relief during labor; yet utilization varies considerably among racial and ethnic groups in the United States—representing a health disparity. Little is known about how maternal and obstetric characteristics may contribute to these differences and whether variation exists among a larger number of racial and ethnic groups. The objective of our study was to evaluate differences in neuraxial labor analgesia use among racial and ethnic groups in the United States. Methods We analyzed vital statistics data from in‐hospital spontaneous vaginal births of singletons during 2016 to 2022 in the United States ( N = 26,345,765). Race and Hispanic ethnicity were considered as social constructs, measured by self‐report, and combined into seven racial and ethnic groups for analysis. The outcome of interest was neuraxial labor analgesia use. We conducted sequentially adjusted multivariable modified Poisson regression models to estimate relative risks (RRs) with 95% confidence intervals (CIs) for associations between racial and ethnic groups and neuraxial labor analgesia. We first adjusted for delivery year and maternal characteristics: age, body mass index, insurance status, and educational background. We then additionally adjusted for obstetric characteristics: timing of prenatal care initiation, gestational age at delivery, and obstetric history (prior live birth and prior cesarean birth). We further descriptively assessed variation in utilization among Asian, Native Hawaiian or Other Pacific Islander (NHOPI), and Hispanic subgroups. Results The rate of neuraxial labor analgesia use was 74% among 15,373,550 spontaneous vaginal, singleton births in the United States. White individuals had the highest rate (78%), and NHOPI and American Indian and Alaska Native (AI/AN) individuals had the lowest rates (58% and 61%, respectively) of use. After adjustment for covariates, the RR of using neuraxial labor analgesia was lowest in NHOPI individuals (0.78; 95% CI, 0.77–0.79) and AI/AN individuals (0.82; 95% CI, 0.82–0.82) compared with White individuals. The fully adjusted RRs were 0.93 (95% CI, 0.93–0.93) for Hispanic individuals, 0.98 (95% CI, 0.98–0.98) for Asian individuals, 0.96 (95% CI, 0.96–0.96) for Black individuals, and 0.97 (95% CI, 0.97–0.98) for multiracial individuals. In a secondary analysis, utilization ranged from 70% to 82% among Asian subgroups, 60% to 69% among NHOPI subgroups, and 64% to 81% among Hispanic subgroups. Conclusions Neuraxial labor analgesia use in the United States was lowest among NHOPI and AI/AN individuals, independent of measured maternal and obstetric characteristics. Efforts are needed to understand and address disparities in contemporary practice with a particular focus on healthcare access and NHOPI and AI/AN communities.