Murthy, K., Grobman, W. A., Lee, T. A., & Holl, J. L. (2008). Medical Care, 46, 900-904.

Racial disparities have been well documented for various healthcare processes, including obstetric care. Rates of labor induction have more than doubled during the last decade. The purpose of this study was to determine racial differences in the increase in the rate of labor induction at term. Data from the National Center for Health Statistics were used to identify pregnant women with singletons at 37 to 41weeks' gestation from 1991 to 2003. Longitudinal regression was used to evaluate the independent association between the induction rate at term and maternal race. Maternal demographic and obstetrical characteristics were viewed as covariates in the analysis. Included in the final model were variables that changed the estimated association between race and induction of labor by at least 20%. Of note, the mean annual induction rates increased significantly during the study period for the entire population and for each racial group. After adjusting for maternal demographic characteristics, obstetrical risk factors for medically indicated induction, and county-level malpractice premium charges, each 1% increase in the proportion of the white and non-white/non-African American populations within a country was associated with significantly higher induction rates (74% and 92%, respectively) in the county. As the authors indicated, although induction rates have increased for all women, the rate of rise has increased disproportionately among women of non-African American race in Illinois. This study was restricted to one state and did not examine whether these disparities are due to differences in physician practice, patient preference, a combination of both, or other broader system factors. Also remaining to be clarified and an important area for future research is how the rising rates of induction affect risk-adjusted rates of cesarean delivery.

Laura L. Hayman