Racial and ethnic disparities in the provision of epidural analgesia to Georgia Medicaid beneficiaries during labor and delivery

Objective The purpose of this study was to measure racial and ethnic differences in the proportion of Medicaid patients who receive epidural analgesia during labor and delivery. Study design Using 1998 Georgia Medicaid claims data in a standard State Medicaid Research File format, we identified claims for epidural analgesia among all women who had a normal vaginal delivery during1998. Results There were 29,833 women who met our inclusion criteria, of whom 15,936 (53.4%) had epidural analgesia. Epidural analgesia rates were lower for black women (49.5%), Hispanic women (35.3%), and Asian women (48.1%) than for white, non-Hispanic women (59.6%; P<.001). Rural women had lower epidural rates (39.2%) than urban women (62.1%). Conclusion The study subjects all had identical Medicaid insurance and met the same low-income Medicaid eligibility criteria, yet race/ethnicity was still a significant predictor of epidural analgesia after we had controlled for age, rural-urban residence, and availability of anesthesiologists. Further studies are needed to assess perceived benefits, risks, costs, and obstacles to epidural analgesia that are perceived by patients, physicians, nurses, and midwives.