Pregnant black women are more tested for drug use – 04/18/2023 – Equilíbrio

Hospitals are more likely to drug test black women about to give birth than white women, regardless of the mother’s substance use history, suggests a new study from a health care system in Pennsylvania.

And these extra tests were unwarranted. The work itself shows that black women were less likely than white women to test positive for drugs.

The study analyzed the electronic medical records of 37,860 patients who gave birth in a large Pennsylvania healthcare system between March 2018 and June 2021 and was published Friday in the JAMA Health Forum.

The report comes amid a debate in the United States about health disparities and systemic racism in medicine, triggered by the disproportionate impact of the Covid-19 pandemic on communities of color and which has most recently focused on high maternal mortality rates among women. black and Native Americans.

The authors of the new study asked hospitals to examine their drug testing practices to address racial bias.

“Any clinician might not be thinking about bias, but when you look at these kinds of data, you can see there’s no other explanation,” says Marian Jarlenski, associate professor of health policy and management at the University of Pittsburgh School of Public Health. and first author of the article.

The findings are a “clear illustration of disparate care,” says Alison Stuebe, a professor of obstetrics and gynecology at the University of North Carolina who was not involved in the research. “This study is an example of how provider behavior makes black women distrustful of the health care system.”

After controlling for various demographic and medical factors, the researchers calculated the likelihood of urine toxicology testing for different groups. Although more black women reported prior drug use, particularly marijuana, the difference does not fully explain the results: they were more likely to have urine tests at the time of delivery, regardless of prior drug use.

Among those who reported substance use in the past year, the likelihood of being tested was 76% for black women, compared with 68% for white women.

However, white women with a history of substance use were more likely to test positive: about 66.7% were likely to test positive, compared to 58% of black patients.

Even among those without a history of substance use, black women were more likely to be tested: about 7% of black patients with no history of substance use were likely to be tested, compared with 4.7% of white women without a history of substance use. history, estimates the study.

It’s unclear what led to increased drug testing of black women in the Pennsylvania health care system. All patients entering the labor department were verbally assessed for substance use, with questions adapted from the US National Institute on Drug Abuse rapid verbal screening test. The policy required that urine drug testing be performed on patients with a positive screening test result, a history of substance use in the year prior to delivery, too few prenatal visits, or a poor delivery outcome without a clear medical explanation.

But history of substance use could not fully explain the results, and the researchers found no racial differences in the number of antenatal visits or the rate of stillbirths.

In addition to calculating probabilities, the paper reported the raw number of patients who were tested for drugs. While approximately 21% of black patients reported a history of drug or alcohol use, 25% underwent urine testing. Most black women reported marijuana use.

In contrast, 9% of white women reported a history of drug use, including marijuana and opioids, while 10% were tested for drugs.

Of the black mothers tested, 40% had positive urine drug tests, compared with 51% of white mothers.

Translated by Luiz Roberto M. Gonçalves