Halliday, L., Shaw, M., Kyzayeva, A., Lawlor, D.A., Nelson, S.M. and Kearns, R.J. (2024) Socio-economic disadvantage and utilisation of labour epidural analgesia in Scotland: a population-based study. Anaesthesia, 79(5), pp. 473-485. (doi: 10.1111/anae.16236) (PMID:38359539)
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Abstract
Socio-economic deprivation is associated with adverse maternal and childhood outcomes. Epidural analgesia, the gold standard for labour analgesia, may improve maternal well-being. We assessed the association of socio-economic status with utilisation of epidural analgesia and whether this differed when epidural analgesia was advisable for maternal safety. This was a population-based study of NHS data for all women in labour in Scotland between 1 January 2007 and 23 October 2020, excluding elective caesarean sections. Socio-economic status deciles were defined using the Scottish Index of Multiple Deprivation. Medical conditions for which epidural analgesia is advisable for maternal safety (medical indications) and contraindications were defined according to national guidelines. Of 593,230 patients in labour, 131,521 (22.2%) received epidural analgesia. Those from the most deprived areas were 16% less likely to receive epidural analgesia than the most affluent (relative risk 0.84 [95%CI 0.82–0.85]), with the inter-decile mean change in receiving epidural analgesia estimated at -2% ([95%CI -2.2% to -1.7%]). Among the 21,219 deliveries with a documented medical indication for epidural analgesia, the socio-economic gradient persisted (relative risk 0.79 [95%CI 0.75–0.84], inter-decile mean change in receiving epidural analgesia -2.5% [95%CI -3.1% to -2.0%]). Women in the most deprived areas with a medical indication for epidural analgesia were still less likely (absolute risk 0.23 [95%CI 0.22–0.24]) to receive epidural analgesia than women from the most advantaged decile without a medical indication (absolute risk 0.25 [95%CI 0.24–0.25]). Socio-economic deprivation is associated with lower utilisation of epidural analgesia, even when epidural analgesia is advisable for maternal safety. Ensuring equitable access to an intervention that alleviates pain and potentially reduces adverse outcomes is crucial.
| Item Type: | Articles |
|---|---|
| Additional Information: | This work was supported by an NHS Research Scotland Career Researcher Fellowship (RK). This work was supported by the Wellbeing of Women (grant to RK) and an NHS Research Scotland Career Researcher Fellowship (RK). DALs contribution is supported by the University of Bristol and UK Medical Research Council (MC_UU_00011/1-6). |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Nelson, Professor Scott and Kyzayeva, Dr Aizhan and Halliday, Dr Lucy and Kearns, Dr Rachel and Shaw, Dr Martin |
| Authors: | Halliday, L., Shaw, M., Kyzayeva, A., Lawlor, D.A., Nelson, S.M., and Kearns, R.J. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | Anaesthesia |
| Publisher: | Wiley |
| ISSN: | 0003-2409 |
| ISSN (Online): | 1365-2044 |
| Published Online: | 15 February 2024 |
| Copyright Holders: | Copyright: © 2024 The Authors |
| First Published: | First published in Anaesthesia 79(5): 473-485 |
| Publisher Policy: | Reproduced under a Creative Commons licence |
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