Table 1. Comparison of Women Who Did Not Receive Neuraxial Analgesia for Vaginal Delivery With Those Who Did, Before and After Inverse Propensity Score Weighting (New York State Hospitals, 2010-2017).
| Characteristic | Before weighting | After weighting | ||||
|---|---|---|---|---|---|---|
| No. (%) | SMD, % | No. (%) | SMD, % | |||
| No neuraxial analgesia (n = 302 603) | Neuraxial analgesia (n = 272 921) | No neuraxial analgesia (n = 304 734) | Neuraxial analgesia (n = 219 308) | |||
| General characteristics | ||||||
| Age, y | ||||||
| ≤19 | 21 983 (7.3) | 17 594 (6.4) | 7.3 | 20 346 (6.7) | 14 347 (6.5) | 1.8 |
| 20-29 | 153 824 (50.8) | 131 552 (48.2) | 151 343 (49.7) | 107 307 (48.9) | ||
| 30-39 | 117 305 (38.8) | 115 127 (42.2) | 123 094 (40.4) | 90 385 (41.2) | ||
| ≥40 | 9491 (3.1) | 8648 (3.2) | 9951 (3.3) | 7269 (3.3) | ||
| Racea | ||||||
| Non-Hispanic Asian or Pacific Islander | 20 796 (6.9) | 25 269 (9.3) | 30.8 | 23 308 (7.6) | 18 366 (8.4) | 9.0 |
| Non-Hispanic Black | 54 749 (18.2) | 33 828 (12.4) | 46 650 (15.3) | 29 350 (13.4) | ||
| Hispanic | 65 924 (22.0) | 38 942 (14.3) | 56 460 (18.5) | 36 476 (16.6) | ||
| Non-Hispanic White | 118 533 (39.5) | 139 743 (51.4) | 135 300 (44.4) | 105 061 (47.9) | ||
| Other | 40 219 (13.4) | 34 315 (12.6) | 43 016 (14.1) | 30 055 (13.7) | ||
| Missing, No. | 2382 | 824 | 0 | 0 | ||
| Residence | ||||||
| Rural | 19 261 (6.4) | 12 517 (4.6) | 7.9 | 16 976 (5.6) | 12 695 (5.8) | <0.1 |
| Urban | 282 252 (93.3) | 259 733 (95.2) | 287 758 (94.4) | 206 613 (94.2) | ||
| Missing, No. | 1090 | 671 | 0 | 0 | ||
| Insurance type | ||||||
| Medicaid | 172 351 (57.0) | 111 516 (40.9) | 39.0 | 150 560 (49.4) | 104 071 (47.5) | 7.5 |
| Medicare | 1382 (0.5) | 1101 (0.4) | 1284 (0.4) | 1035 (0.5) | ||
| Private | 109 611 (36.2) | 149 732 (54.9) | 137 696 (45.2) | 104 559 (47.7) | ||
| Self-pay (uninsured) | 11 354 (3.8) | 4494 (1.6) | 8071 (2.6) | 3956 (1.8) | ||
| Other | 7902 (2.6) | 6078 (2.2) | 7123 (2.3) | 5687 (2.6) | ||
| Missing, No. | NAb | 0 | 0 | 0 | ||
| CMI-OB | ||||||
| 0 (Low risk) | 214 471 (70.9) | 185 875 (68.1) | 6.0 | 211 159 (69.3) | 150 698 (68.7) | 1.2 |
| ≥1 (High risk) | 88 132 (29.1) | 87 046 (31.9) | 93 575 (30.7) | 68 610 (31.3) | ||
| Obesity | 15 349 (5.1) | 13 579 (5.0) | <1.0 | 16 451 (5.4) | 10 299 (4.7) | 3.2 |
| Possible contraindications to neuraxial anesthesia | ||||||
| Coagulation factor deficit, Von Willebrand disease, and thrombocytopenia | 5757 (1.9) | 6107 (2.2) | 2.4 | 6645 (2.2) | 4796 (2.2) | <0.1 |
| Fever or infection during labor | 2412 (0.8) | 2634 (1.0) | 1.8 | 2825 (0.9) | 1826 (0.8) | 1.0 |
| Chorioamnionitis | 6044 (2.0) | 7622 (2.8) | 5.2 | 7576 (2.5) | 4830 (2.2) | 1.9 |
| Pregnancy and labor characteristics | ||||||
| Admission for delivery during a weekend | 72 604 (24.0) | 64 144 (23.5) | 1.2 | 72 460 (23.8) | 52 128 (23.8) | <0.1 |
| Pregnancy resulting from ART | 553 (0.2) | 1148 (0.4) | 4.2 | 1046 (0.3) | 755 (0.3) | <0.1 |
| Previous cesarean delivery | 8257 (2.7) | 7476 (2.7) | <1.0 | 8513 (2.8) | 6171 (2.8) | <0.1 |
| Uterus fibroid | 2392 (0.8) | 2485 (0.9) | 1.3 | 3090 (1.0) | 1901 (0.9) | 1.5 |
| Polyhydramnios | 1911 (0.6) | 2308 (0.8) | 2.5 | 2409 (0.8) | 1664 (0.8) | <0.1 |
| Placenta praevia | 401 (0.1) | 360 (0.1) | <0.1 | 443 (0.1) | 291 (0.1) | <0.1 |
| Placenta accreta | 913 (0.3) | 1171 (0.4) | 2.1 | 1179 (0.4) | 864 (0.4) | <0.1 |
| Multiple gestation | 2003 (0.7) | 2495 (0.9) | 2.9 | 2728 (0.9) | 1782 (0.8) | <0.1 |
| Abnormal presentation | 8999 (3.0) | 8062 (3.0) | <1.0 | 9815 (3.2) | 6723 (3.1) | <0.1 |
| Preterm delivery | 17 077 (5.6) | 12 705 (4.7) | 4.5 | 15 848 (5.2) | 12 237 (5.6) | 1.7 |
| Premature rupture of membranes | 17 461 (5.8) | 24 265 (8.9) | 12.0 | 22 116 (7.3) | 16 444 (7.5) | <0.1 |
| Induction of labor | 56 458 (18.7) | 67 178 (24.6) | 14.5 | 70 891 (23.3) | 47 901 (21.8) | 3.4 |
| Abnormal fetal heart rhythm | 38 509 (12.7) | 50 405 (18.5) | 15.9 | 51 328 (16.8) | 34 198 (15.6) | 3.4 |
| Hospital characteristics | ||||||
| Teaching hospital | 240 277 (79.4) | 229 617 (84.1) | 12.3 | 251 094 (82.4) | 176 903 (80.7) | 4.5 |
| Rural hospital | 16 330 (5.4) | 7461 (2.7) | 13.5 | 12 475 (4.1) | 8792 (4.0) | <0.1 |
| Annual deliveries, mean (SD) | 2684 (1797) | 3455 (2137) | 39.1 | 3181 (2185) | 3224 (2065) | 2.0 |
| Cesarean delivery rate, mean (SD) | 33.3 (6.5) | 34.4 (6.5) | 16.7 | 33.7 (6.5) | 33.8 (6.5) | 2.1 |
| Proportion of induction of labor, mean (SD) | 16.4 (7.6) | 18.3 (7.8) | 24.9 | 17.7 (7.6) | 17.6 (7.6) | 1.7 |
| Proportion of racial and ethnic minority women, mean (SD) | 57.9 (31.2) | 48.7 (26.3) | 32.2 | 53.8 (29.3) | 50.5 (28.2) | 11.5 |
| Proportion of women who are safety net patients, mean (SD)c | 58.2 (27.5) | 43.5 (24.2) | 56.8 | 51.4 (26.5) | 47.8 (24.9) | 13.8 |
| Proportion of women with CMI-OB ≥1, mean (SD) | 43.0 (6.5) | 45.3 (7.1) | 33.8 | 44.5 (7.1) | 44.3 (7.5) | 3.7 |
| Proportion of admission for delivery during a weekend, mean (SD) | 20.7 (2.0) | 20.5 (2.2) | 7.4 | 20.6 (2.1) | 20.7 (2.1) | 3.9 |
| Proportion of neuraxial techniques in deliveries, mean (SD) | 22.1 (28.0) | 71.8 (17.3) | 213.3 | 46.0 (33.8) | 58.5 (25.6) | 41.6 |
| Coding intensity, mean (SD) | 8.0 (1.5) | 8.3 (1.6) | 24.9 | 8.2 (1.6) | 8.2 (1.6) | 3.4 |
| Hospital county characteristics (per 1000 in-hospital births in the county), mean (SD) | ||||||
| Obstetricians and gynecologists | 13.4 (4.7) | 14.7 (4.7) | 27.7 | 14.0 (4.8) | 14.0 (4.9) | 1.1 |
| Physician anesthesiologists | 15.5 (6.9) | 17.7 (6.2) | 33.8 | 16.4 (6.8) | 16.6 (6.7) | 3.1 |
| Certified registered nurse anesthetists | 4.9 (4.4) | 6.3 (5.5) | 27.9 | 5.5 (5.2) | 5.9 (5.3) | 8.7 |
| Year of delivery | ||||||
| 2010-2011 | 91 737 (30.3) | 79 609 (29.2) | 5.1 | 82 272 (27.0) | 66 774 (30.4) | 9.8 |
| 2012-2013 | 79 802 (26.4) | 69 220 (25.4) | 75 810 (24.9) | 53 705 (24.5) | ||
| 2014-2015 | 75 845 (25.1) | 69 411 (25.4) | 87 131 (28.6) | 54 555 (24.9) | ||
| 2016-2017 | 55 219 (18.2) | 54 681 (20.0) | 59 520 (19.5) | 44 274 (20.2) | ||
Abbreviations: ART, assisted reproductive technology; CMI-OB, comorbidity index for obstetric patients; NA, not applicable; SMD, standardized mean difference.
a
Data on race were taken from the New York State Inpatient Database. In the State Inpatient Database, race and ethnicity includes 7 mutually exclusive categories: non-Hispanic Asian or Pacific Islander, non-Hispanic Black, Hispanic, Native American, non-Hispanic White, other race and ethnicity, and missing. Because of the low number of Native American women in the study sample, these women were included in the other race and ethnicity group.
b
Because of Healthcare Cost and Utilization Project data use agreement restrictions on small cell size, the number of observed cases and exact proportions are not presented.
c
Safety net patients are Medicaid beneficiaries, Medicare beneficiaries, and uninsured.