Tussing AD, Wojtowycz MA; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1283.
Syracuse University, Economics, 110 Eggers Hall, Syracuse, NY 13244 Tel. 315-443-2642 Fax 315.443.3717
RESEARCH OBJECTIVE: Race black increases the probability of a diagnosis of fetal distress in childbirth. While it is likely that low socioeconomic status associated with race black is responsible for risk factors that pose enhanced dangers to the fetus in labor and delivery, it is also possible that there may be some institutional biases that account for some part of the elevated prevalence of fetal distress in black mothers. In other words, there may truly be higher levels of risk of fetal distress among black mothers, but there may also be systemic tendencies to use that diagnosis more frequently for that population.The purpose of the study is to determine whether and to what extent there is a systematic tendency use the diagnostic label of fetal distress more frequently for births to black mothers. We do so by exploring the relationship between the use of the fetal distress label and Apgar score.There should be a pattern of general agreement between the diagnosis of fetal distress and Apgar score. In effect, the diagnosis of fetal distress is a prediction that, in the absence of some intervention, the fetus will experience difficulties, primarily of a respiratory nature. Respiratory problems of the sort predicted mean a lower Apgar score.Because neither the diagnosis of fetal distress nor the Apgar method of scoring is perfect, there are reasons to expect that the diagnosis of fetal distress will not uniformly be followed by an appropriate low Apgar score. In general, however, the occurrence of reported fetal distress with high Apgar score should be largely random. This paper investigates non-random occurrence of reported fetal distress with high Apgar score. It examines whether and to what extent this measure is associated with other variables, notably maternal race, controlling for other factors that might contribute to low Apgar. STUDY DESIGN: We estimate a single-equation logistic regression, in which the dependent variable is fetal distress with high Apgar score, i.e., a dichotomous variable, equal to one for deliveries in which there has been a diagnosis of fetal distress and where there has been a one-minute Apgar score of 7 or greater. POPULATION STUDIED: Data consist of 20,000 obstetric deliveries in New York State for 1997, a merge of vital records and hospital discharge data. The data set is a rich one, including maternal characteristics and obstetric background;complications of pregnancy, labor, and delivery; physician and hospital characteristics; and such economic factors as ratio of number of obstetricians to population of fertile-aged women, and malpractice exposure. PRINCIPAL FINDINGS: Fetal distress with high Apgar score is far from random. A number of variables, most notably race black, and also including other variables correlated with low socioeconomic status, are significantly associated with the variable, when other relevant variables are controlled for. CONCLUSIONS: It appears that black mothers and mothers with low socioeconomic status are more likely to be diagnosed with fetal distress when Apgar scores are high. The explanation may be that these cases are more difficult to diagnose. Alternatively, it may be that these patients are treated by less skilled physicians, and/or that other types of bias exist. Whatever the explanation, it does appear that some part of the elevated prevalence of fetal distress among black mothers is due to variations in diagnostic behavior as opposed to true differences in risk to the fetus. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Further research is needed, first, to see whether these findings are validated in other geographic regions and using other tests, and second, if they are, to find exactly where the bias occurs. If others find similar patterns of bias in the use of the fetal distress label, research in appropriate remedies, such as improved definitions of fetal distress or protocols in diagnostic behavior, and possibly strengthened obstetric training, are indicated. Another implication is that fetal distress with high Apgar might be considered as a new indicator to track quality of care.
Publication Types:
Keywords:
- Apgar Score
- Bias (Epidemiology)
- Delivery, Obstetric
- Female
- Fetal Distress
- Humans
- Labor, Obstetric
- Logistic Models
- Mothers
- New York
- Parturition
- Pregnancy
- Risk Factors
- diagnosis
- surgery
- hsrmtgs
UI: 103624317
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