Racial disparity seen in use of epidural blood patches for postdural headaches

Epidural blood patches (EBPs) are used less often or use is delayed for patients in racial and ethnic minority groups compared with White patients, according to a study published online April 21 in JAMA Network Open.

Allison Lee, M.D., from the Columbia University Irving Medical Center in New York City, and colleagues examined whether patients in racial and ethnic minority groups giving birth receive an EBP for management of postdural puncture headache after neuraxial procedures less frequently than non-Hispanic White patients. The analysis included data from 8,921 patients (11.5 percent Black and 14.6 percent Hispanic) with postdural puncture headache.

The researchers found that 47 percent of patients were managed with an EBP (53.4 percent among White patients, 41.7 percent among Hispanic patients, 35.7 percent among Black patients, and 35.2 percent among patients of other race and ethnicity). Timing of EBP was longer for non-White patients (median of two days after hospital admission for White patients versus three days for Hispanic patients, Black patients, and patients of other race and ethnicity). The EBP rate did not differ between White and Hispanic patients (adjusted odds ratio [OR], 1.11; 95 percent confidence interval [CI], 0.94 to 1.30) when adjusting for patient and hospital characteristics, but it was significantly lower for Black patients (adjusted OR, 0.80; 95 percent CI, 0.67 to 0.94) and patients of other races and ethnicities (adjusted OR, 0.85; 95 percent CI, 0.73 to 0.99) versus White patients.

"These findings suggest that there is a need to address racial and ethnic disparities in the management and prevention of serious complications associated with obstetric anesthesia care," the authors write.

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