Bronstein JM, Cliver S, Goldenberg RL.
AHSR FHSR Annu Meet Abstr Book. 1995; 12: 104.
Department of Health Care Organization and Policy, University of Alabama, Birmingham 35294, USA.
PROBLEMS AND OBJECTIVES. The administration of corticosteroids to women in preterm labor enhances fetal lung maturity and thus improves outcomes for infants born prematurely. There is wide variation in the use of this intervention, but non-white infants consistently receive this intervention less frequently than white infants. This study identifies the factors associated with this racial disparity in use of the intervention. DATA AND METHODS. The five-center March of Dimes Prematurity Prevention Trial in the 1980's produced 4625 records of early labor encounters. Corticosteroid and tocolytic therapy were used at the physician's discretion in the trial. We used logistic regression analysis to examine the association between maternal clinical and demographic characteristics and administration of corticosteroids during the encounter. RESULTS AND CONCLUSIONS. Controlling for maternal age, parity, multiple births, gestational age, features of labor, use of tocolytics (to delay labor) and center, both black and Hispanic women were significantly less likely to receive corticosteroids than white women. Modeling the use of corticosteroids separately for black and white women indicated that factors often cited as reasons not to administer corticosteroids -- gestational age less than 24 weeks and very early stage of labor -- were negatively associated with the intervention for black women but not for white women. IMPLICATIONS FOR THE AUDIENCE. Our findings suggest that the expansion of corticosteroid use to cases where opinion has previously held that effectiveness is uncertain is occurring selectively; patient race/ethnicity is associated with the selection of which very premature infants will receive this intervention.
Publication Types:
Keywords:
- Adrenal Cortex Hormones
- African Americans
- African Continental Ancestry Group
- Ethnic Groups
- European Continental Ancestry Group
- Female
- Gestational Age
- Hispanic Americans
- Humans
- Infant
- Infant, Newborn
- Infant, Premature
- Labor, Obstetric
- Maternal Age
- Mothers
- Obstetric Labor, Premature
- Pregnancy
- Tocolysis
- Tocolytic Agents
- utilization
- hsrmtgs
Other ID:
UI: 102215614
From Meeting Abstracts