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Socioeconomic Deprivation and Utilization of Anesthetic Care During Pregnancy and Delivery: A French Retrospective, Multicenter, Cohort Study

Kantor, Elie MD*‡; Guglielminotti, Jean MD, PhD‡§; Azria, Elie MD, PhD‖¶; Luton, Dominique MD, PhD#; Laurent, Mandelbrot MD, PhD**; Oury, Jean-François MD, PhD††; Mahieu-Caputo, Dominique MD, PhD†,‡‡; Ravaud, Philippe MD, PhD§§‖‖; Estellat, Candice MD, PhD¶¶##; PreCARE Study Group

doi: 10.1213/ANE.0000000000002275
Obstetric Anesthesiology: Original Clinical Research Report

BACKGROUND: Socioeconomic deprivation is associated with reduced use of antenatal resources and poor maternal outcomes with pregnancy. Research examining the association between socioeconomic deprivation and use of obstetric anesthesia care in a country providing universal health coverage is scarce. We hypothesized that in a country providing universal health coverage, France, socioeconomic deprivation is not associated with reduced use of anesthetic care during pregnancy and delivery. This study aimed to examine the association between socioeconomic deprivation and (1) completion of a mandatory preanesthetic evaluation during pregnancy and (2) use of neuraxial analgesia during labor.

METHODS: Data were from a cohort of 10,419 women who delivered between 2010 and 2011 in 4 public teaching hospitals in Paris. We used a deprivation index that included 4 criteria: social isolation, poor housing condition, no work-related household income, and state-funded health care insurance. Socioeconomic deprivation was defined as a deprivation index greater than 1. Preanesthetic evaluation was considered completed if performed more than 48 hours before delivery. The association between socioeconomic deprivation and completion of the preanesthetic evaluation and use of neuraxial labor analgesia was assessed by multivariable logistic regression adjusting for education level, country of birth, and maternal and pregnancy characteristics.

RESULTS: Preanesthetic evaluation was completed for 8142 of the 8624 women (94.4%) analyzed and neuraxial labor analgesia was used by 6258 of the 6834 women analyzed (91.6%). After adjustment, socioeconomic deprivation was associated with reduced probability of completed preanesthetic evaluation (adjusted odds ratio 0.88 [95% confidence interval, 0.79–0.98]; P = .027) but not use of neuraxial labor analgesia (adjusted odds ratio 0.97 [95% confidence interval, 0.87–1.07]; P = .540).

CONCLUSIONS: In a country providing universal health care coverage, women who were socioeconomically deprived showed reduced completion of preanesthetic evaluation during pregnancy but not reduced use of neuraxial labor analgesia. Interventions should be targeted to socioeconomically deprived women to increase the completion of the preanesthetic evaluation.

Published ahead of print July 13, 2017.

From the *Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique (CIC) 1425-Epidémiologie Clinique (EC), UMR 1123, Paris, France; Département d’Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France; §INSERM, Unité Mixte de Recherche 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, France; INSERM, UMR 1153, Équipe de Recherche en épidémiologie Obstétricale Périnatale et Pédiatrique, Université Paris Descartes, Paris, France; Maternité Notre Dame de Bon Secours, Groupe Hospitalier Paris Saint Joseph, Paris, France; #Service de Gynécologie-Obstétrique, Hôpital Beaujon, AP-HP, Clichy, France; **Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, AP-HP, Colombes, France; ††Service de Gynécologie-Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France; ‡‡Service de Gynécologie-Obstétrique, Hôpital Bichat, AP-HP, Paris, France; §§Centre d’Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France; ‖‖Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Université Paris Descartes, Paris, France; ¶¶Centre de Pharmaco-épidémiologie de l’AP-HP, Unité de Recherche Clinique des Hôpitaux Universitaires Pitié Salpêtrière – Charles Foix, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris France; and ##INSERM, UMR 1123 Epidémiologie Clinique et évaluation économique Appliquées aux Populations Vulnérables, Paris, France.

Published ahead of print July 13, 2017.

Accepted for publication May 9, 2017.

Funding: The French Ministry of Health funded the PreCARE study (Programme Hospitalier de Recherche Clinique National [PHRC AOM] 07079), Elie Kantor received a grant from the French Ministry of Health and from the “Club d’Anesthésie –Réanimation en Obstétrique” (CARO) for this ancillary study.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

The results of the current study had been presented as an abstract at the annual SOAP Meeting (Society for Obstetric Anesthesia and Perinatology), in Boston, May 2016.

Institutional Review Board: The PreCARE study was approved by the “Comité de protection des personnes Ile de France 1.” Contact information: Hôpital Hôtel-Dieu, 1 place du Parvis-de-Notre-Dame, 75181 Paris Cedex 04, France. E-mail: cpp.iledefrance1@htd.aphp.fr.

†Deceased.

A complete list of members may be found in Appendix 1.

Reprints will not be available from the authors.

Address correspondence to Elie Kantor, MD, Département d’Epidémiologie et Recherche Clinique, URC Paris-Nord, Hôpital Bichat-Claude Bernard, AP-HP, 46 rue Henri Huchard, 75018 Paris, France. Address e-mail to elie.kantor@gmail.com.

© 2017 International Anesthesia Research Society
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