Ethnicity, socio-economic deprivation and postpartum outcomes following caesarean delivery: a multicentre cohort study

J E O'Carroll; L Zucco; E Warwick; G Radcliffe; S R Moonesinghe; K El-Boghdadly; N Guo; B Carvalho; P Sultan; ObsQoR Collaborators

doi:10.1111/anae.16241

Ethnicity, socio-economic deprivation and postpartum outcomes following caesarean delivery: a multicentre cohort study

Anaesthesia. 2024 May;79(5):486-497. doi: 10.1111/anae.16241. Epub 2024 Feb 15.

Authors

J E O'Carroll^{1

2}, L Zucco³, E Warwick⁴, G Radcliffe³, S R Moonesinghe^{5

2}, K El-Boghdadly^{6

7}, N Guo¹, B Carvalho¹, P Sultan¹; ObsQoR Collaborators

Collaborators

ObsQoR Collaborators:
C Abayasinghe, C Abeywardana, L Adams, M Aduse-Poku, M Agarwal, D Ahmed, P Ahuja, H Ali, G Allen, H Aly, H Anderson, P Annamalai, S Appiah, G Arbane, A Arch, S Armstrong, A Ashraf, D Athorn-Wright, R Atkinson, L Austin, B Badal, S Bajaj, M Baker, O Balogun, S Bampoe, D Banni, H Barnes, L Barnes, N Barot, R Barr, R Bassi, L Baxendale, S Beadle, H Beard, F Beatty, S Beeby, J Bell, S Bell, R Benlloch, T Benn, H Bennett, E Beranova, S Berry, H Bethell, K Bhatia, S Bhattacharyya, B Bhattari, R Bhimanaboina, M Bigwood, S Bircham, J Biss, J Bland, O Blightman, P Botchway, L Bouras, J Bowditch, H Boyle, M Bradshaw, L Brady, J Brain, C Brathwaite-Shirley, S Brayshaw, C Bressington, F Brewer, D Bromley, E Brown, J Brown, N Brown, B Brown, D Bruynseels, R Buckley, I Bukowska, S Burnard, R Burnell, R Burnish, C Busby, J Butler, T Camburn, R Campbell, N Campbell, L Canclini, V Cannons, J Cantliffe, A Carey, J Carpenter, J Carpenter, R Carrington, S Carta, R Cassin, G Castle, I Chadderton, K Chadwick, C Challifour, K Cheong, V Cherian-McIvor, R Chirvasuta, T Christmas, A Christopolou, E Clarey, D Cochran, N Coker, A Colhoun, K Colling, E Collins, J Collins, V Collins, G Colville, S Connelly, A Connolly, K Conolloy, C Cooper, S Cope, J Coppel, C Cormack, R Cortaville, D Cottam, S Cotterell, S Cousins, P Coutts, A Cowan, C Craig, C Crail, J Critchley, R Crosby, C Cross, G Crossingham, C Crossland, T Cruz Cervera, O Cummin, S Curtis, S Cusick, A Das, G Davenport, X David, R Davies, J Davies, H Davies, C de la Iglesia, T Dean, J Dearden, K Death, J Deery, C Denford, E Derby, J Desai, C Diaz, M Dissanayake, C Dixon, B Doleman, S Donlon, E Dooks, B Downs, E Duckham, H Dudhill, J Dunning, I Eka, Z Eke, L Elam, A Elfaioumy, R Ellis, C Ellis, A Ellison, C Elton, D Endersby, S Essien, K Evans, J Evans, L Evans, E Finlay, J Finn, R Fishwick, S Fisk, O Flood, V Fludder, M Flynn-Batham, M Flynn-Batham, K Foreman, M Forsey, A Foulds, C Fox, N Freeman, R Fronda, O Froud, L Fulton, M Gaines, F Gallop, L Garden, A Garnder, Z Garner, G Garvey, N Gautam, J Gavin, L Gentle, A Gerth, R Goel, B Gohil, B Goodman, A Gosal, E Gott, S Gowans, C Graham, H Grant, R Greaves, J Greenwood, H Griffiths, J Grindey, Z Grindley, M Guanco, N Guirguis, A Gulati, T Hall, B Hammond, S Hammond, A Hania, A Harish Dave, L Harkett, S Harris, E Hart, J Haslam, R Hawes, F Hayat, S Hazeldine, T Hazelton, R Heard, L Helley, H Hemantha, C Hemeson, S Hendy, S Henry, M Henwood, M Hickson, A Hill, J Hillen, E Hindle, S Hird, G Hobden, R Holcombe-Law, H Hollands, R Holmes, X Holmwood, J Hooper, K House, S Howells, K Hoyland, J Hudsmith, A Hughes, D Hughes, C Hunt, A Hunt, C Huson, C Hussain, T Hussey, R Hyrniv, H Ibrahim, H Iliff, L Imam, H Ingram, H Ingram, E Innes, R Ions, A Isherwood, P Jackson, P Jackson, N Jacques, V Jain, P Jain, R Jama, M Jarvis, J Jennings, H Jennison, R Jesty, B Joakim, J Johal, G John, N John, B Johnston, J Johnston, B Jones, S Jones, K Jones, K Jones, R Jones, E Kalam-Sakit, P Kamath, A Kapoor, A Kaul, L Kavanagh, R Kearns, A Kelkar, N Kennedy, S Kent, J Kenworthy, C Kenyon, T Keown, M Keskar, S Kestner, A Khan, G Khanvelkar, R Khorasanee, S Kimber-Craig, G Kirby, M Klukowski, G Knight, S Knights, A Kostroglou, S Kreppel, A Kumar, N Kurunaratne, K Lake, R Lakhani, B Lalabekyan, B Lally, C Lanaghan, G Landers, T Langcake, M Law, V Laxton, J Le Bas, S Leach, T Lewis, J Lie, S Liggett, H Lindsay, E Lloyd-Davies, V Lowden, R Lucas, B MacAfee, K Maclachlan, B Madhavan, J Major, K Mak, A Malik, H Manteigas, M Maquinana, C Marsh, M Marta, N Martin, G Martir, T Mathew, A Mathews, M Mawathage, M McCague, D McCartney, C McCaul, G McClune, D Mccretton, L McDowell, C McGrath, S McGuirk, A McIlroy, S McLeavey, N McLoughlin, O McNally, H McNamara, E Meadows, A Medniuk, A Melia, Y Metodiev, S Milewczyk, S Miller, A Mills, M Milner, K Miltsios, L Mitchell, M Mittal, A Mohd Azmil, A Moon, C Moore, D Moore, A Morgan, R Mostyn, C Mowat, C Muir, C Mullington, P Nabayego, J Nagari Radhakrishna, P Nalwaya, S Napier, A Nevis, S Ng, A Nicholson, A Nicklin, K Norman, S Nugent, G O'Connor, B O'gara, C Obiozo, R Ochoa-Ferraro, P Odedra, M Ogbomo, D Onwochei, C Ord, L Oshodi, S Pai, R Pallab, P Pankhadiwala, C Papageorgiou, C Papoutsos, J Parker, R Parker, A Parrish, M Patel, K Patel, H Pearson, B Peers, M Penacerrada, S Pepper, G Perkins, S Peroos, K Peshimam, R Phillips, S Phillips, J Pike, J Pike, A Pillai, R Plachikkattle Velu, E Plunkett, M Poole, S Poon, R Powell, L Powell, R Prabhakaran, B Prince, C Prince, Y Prior, J Pullen, S Purvis, R Puttaswamy, A Qaiser, S Quasim, A Quinn, N Qureshi, J Radford, S Rahim, S Rai, A Rand, B Reed, A Rehman, J Retief, A Reyes, J Reynolds, J Reynolds, L Rhodes, K Rhodes, E Rice, M Rich, N Richards, C Rimmer, C Rishton, J Ritzema, L Robbins, S Roberts, B Roberts, E Roberts, K Robins, K Robinson, R Robley, M Roche, J Rochester, N Rodal-Prieto, R Rohit, H Rosser, J Rothwell, L Sach, S Saha, B Saji, K Salmon, V Salota, A Salvana, A Sanderson, L Sanderson, R Sandhar, Z Sarwar, A Sawyerr, R Scale, A Scott, E Searle, H Sellers, S Seraj, R Shankar, S Sharafudeen, I Sharieff, T Sharp, A Sharp, J Shaw, M Shekar, C Shelton, B Shelton, M Sherwin, J Short, A Short, M Simpson, A Singh, V Singler, A Sinha, M Sinnott, S Sivaramakrishnan, E Smee, K Smith, R Smith, R Solly, A Soundararajan, E Sousi, K Spence, P Squires, L Stephenson, J Stewart, K Stoddard, S Stone, M Stubbs, A Sturmey, G Suddick, G Suleymanova, V Sundararajan, S Sundayi, S Supermanian, P Surgey, L Swaminathan, K Swettenham, P Swift, J Syson, H T-Michael, P Tamhane, P Tamilselvan, T Tanqueray, E Tanqueray, E Tanton, S Taylor, L Taylor, C Taylor, S Thomas, C Thomas, E Thompson, A Thomson, O Tim, J Tipper, J Towning, C Townsend, M Traves, S Turney, V Turnock, S Twiss, C Uduwela, L Ufton, D Uncles, E Underhill, M Usher, M Vaidya, A Van-Hien, R Varadan, H Venkatesh, P Verma, L Vickers, M Victoria, I Volikas, R Volk, E Waddell, H Waddington, J Wagstaff, J Walker, G Wallace, M Walters, E Walton, A Ware, R Warren, R Watson, E Wells, C Weston, S Wheeler-Davies, S Wheeler-Davies, C Whelan, N White, K Whitehouse, N Wickramasinghe, T Wieder, M Wikner, H Wild, J Wilkinson, D Wilkinson, L Williams, B Williams, C Williams, L Willsher, S Wilson, J Wilson, A Wimalaratne, A Windle, A Wise, D Wixted, J Woollaston, M Woolnough, T Wooten, C Wyatt, P Wyatt, D Wyndham, A Yousef, P Yoxall, M Zawadzka, X Zhao, L Zucco

Affiliations

¹ Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
² Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London.
³ Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁴ Anaesthesia and Perioperative Medicine, University College London Hospitals, London, UK.
⁵ University College London Hospitals, London, UK.
⁶ Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁷ King's College London, London, UK.

PMID: 38359531
DOI: 10.1111/anae.16241

Abstract

Disparities relating to postpartum recovery outcomes in different socio-economic and racial ethnic groups are underexplored. We conducted a planned analysis of a large prospective caesarean delivery cohort to explore the relationship between ethnicity, socio-economic status and postpartum recovery. Eligible patients were enrolled and baseline demographic, obstetric and medical history data were collected 18 h and 30 h following delivery. Patients completed postpartum quality of life and recovery measures in person on day 1 (EuroQoL EQ-5D-5L, including global health visual analogue scale; Obstetric Quality of Recovery-10 item score; and pain scores) and by telephone between day 28 and day 32 postpartum (EQ-5D-5L and pain scores). Socio-economic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence. Data from 1000 patients who underwent caesarean delivery were included. There were more patients of Asian, Black and mixed ethnicity in the more deprived quintiles. Patients of White ethnicities had shorter postpartum duration of hospital stay compared with patients of Asian and Black ethnicities (35 (28-56 [18-513]) h vs. 44 (31-71 [19-465]) h vs. 49 (33-75 [23-189]) h, respectively. In adjusted models at day 30, patients of Asian ethnicity had a significantly greater risk of moderate to severe pain (numerical rating scale ≥ 4) at rest and on movement (odds ratio (95%CI) 2.42 (1.24-4.74) and 2.32 (1.40-3.87)), respectively). There were no differences in readmission rates or incidence of complications between groups. Patients from White ethnic backgrounds experience shorter postpartum duration of stay compared with patients from Asian and Black ethnic groups. Ethnic background impacts pain scores and recovery at day 1 postpartum and following hospital discharge, even after adjusting for socio-economic group. Further work is required to understand the underlying factors driving differences in pain and recovery and to develop strategies to reduce disparities in obstetric patients.

Keywords: disparity; ethnicity; patient‐reported outcome measures; postpartum recovery; socio‐economic factors.

Publication types

Multicenter Study

MeSH terms

Cesarean Section
Ethnicity*
Female
Humans
Pain
Postpartum Period
Poverty
Pregnancy
Prospective Studies
Quality of Life*

Grants and funding

Obstetric Anaesthetists' Association