Alexander J. Butwick|Jason Bentley|Cynthia A. Wong|Jonathan M. Snowden|Eric Sun|Nan Guo
United States State-Level Variation in the Use of Neuraxial Analgesia During Labor for Pregnant Women
Stanford University|Stanford University|University of Iowa|Portland State University|Oregon Health & Science University|Stanford University|Stanford University
neuraxial labor analgesia recognized effective method providing pain relief labor little known variation rates neuraxial analgesia across us states identifying presence extent variation may provide insights practice variation may indicate access neuraxial analgesia inadequateto test hypothesis variation exists neuraxial labor analgesia use among us statesretrospective populationbased crosssectional analysis using us birth certificate data participants 2 625 950 women underwent labor 2015statespecific prevalence neuraxial analgesia per 100 women underwent labor variability neuraxial analgesia use among states assessed using multilevel multivariable regression modeling median odds ratio intraclass correlation coefficient evaluate variation statein study population 2 625 950 women 01 n 2010 younger 15 years 70 n 183 546 ages 15 19 years 236 n 620 118 ages 20 24 years 296 n 777 957 ages 25 29 years 260 n 683 656 ages 30 34 years 114 n 298 237 ages 35 39 years 22 n 57 130 ages 40 44 years 01 n 3296 ages 45 54 years 90 privately insured insured medicaid neuraxial analgesia used 731 n 1 920 368 women adjustment antepartum obstetric intrapartum factors maine lowest neuraxial analgesia prevalence 366 95 ci 332401 nevada highest 801 95 ci 783817 adjusted median odds ratio 15 95 ci 1416 intraclass correlation coefficient 54 95 ci 4079results study suggest small portion overall variation neuraxial analgesia use explained us states unmeasured patientlevel hospitallevel factors likely account large portion variation states efforts made understand main reasons variation whether variation influences maternal perinatal outcomes