Social disparity and the use of intrapartum epidural analgesia in a publicly funded health care system

OBJECTIVE: We sought to examine the difference in use of labor epidural analgesia among women from different neighborhood socioeconomic groups. STUDY DESIGN: Neighborhood socioeconomic variables from the 2001 Canadian Census were linked to singleton vaginal births from the Niday perinatal database (2004-2006) in Ontario, Canada. Births were divided into income and education groups by quintiles. Generalized estimating equations were employed to evaluate the association between labor epidural and neighborhood socioeconomic status. Supplementary analysis was conducted after stratifying data by hospital types. RESULTS: Compared with those from the richest neighborhood, women from the poorest quintile were the least likely to receive labor epidural analgesia (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.58-0.61). The differences were smallest in teaching hospitals (OR, 0.73; 95% CI, 0.67-0.79) and largest in small community hospitals (OR, 0.57; 95% CI, 0.50-0.64). Similar association was found in neighborhood education quintiles. CONCLUSION: The use of labor epidural analgesia is decreased with decreasing neighborhood economic and education levels.