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Asian-white disparities in obstetric anal sphincter injury: Protocol for a systematic review and meta-analysis
Meejin Park1, Susitha Wanigaratne2, Rohan D'Souza3,4
1Faculty of Health Sciences, Department of Global Health, McMaster University, Hamilton, ON, Canada.
Insights
This systematic review investigates obstetric anal sphincter injuries (OASI) in high-income countries. It hypothesizes a higher incidence of OASI in Asian versus white birthing individuals, aiming to inform equitable obstetric care.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Epidemiology
- Health Disparities Research
Background:
- Obstetric anal sphincter injury (OASI) affects 4.4%–6.0% of vaginal births in Canada.
- Existing research indicates a higher OASI risk in Asian versus white individuals in high-income countries.
- This protocol details a systematic review and meta-analysis to quantify this disparity.
Purpose of the Study:
- To determine the incidence of OASI in Asian versus white birthing individuals in high-income countries.
- To hypothesize a higher pooled incidence of OASI in Asian compared to white birthing individuals.
- To inform potential disparities in obstetric care and outcomes.
Main Methods:
- Systematic search of MEDLINE, OVID, Embase, Emcare, and Cochrane databases (inception–2022).
- Inclusion of observational studies using keywords related to race, ethnicity, and OASI.
- Meta-analysis using RevMan with random effects model and odds ratio (OR) for dichotomous data; subgroup analysis by Asian ethnicity.
Main Results:
- The study aims to synthesize extant literature to estimate OASI rates in Asian and white populations.
- It will calculate the relative risk of OASI between these two ethnic groups in non-Asian, high-income settings.
- The expected outcome is to provide quantitative evidence on the incidence disparity.
Conclusions:
- Findings will illuminate health outcome discrepancies between Asian and white birthing individuals.
- Results may advocate for research into causal mechanisms like differential care and systemic racism.
- The review aims to inform obstetric care guidelines for equitable and accessible healthcare for diverse populations.
Background:
Obstetric anal sphincter injury (OASI) describes severe injury to the perineum and perineum and perianal muscles following birth and occurs in 4.4% to 6.0% of vaginal births in Canada. Studies from high-income countries have identified an increased risk of OASI in individuals who identify as Asian race versus those who identify as white. This protocol outlines a systematic review and meta-analysis which aims to determine the incidence of OASI in individuals living in high-income countries who identify as Asian versus those of white race/ethnicity. We hypothesize that the pooled incidence of OASI will be higher in Asian versus white birthing individuals.
Methods:
We will search MEDLINE, OVID, Embase, Emcare and Cochrane databases from inception to 2022 for observational studies using keywords and controlled vocabulary terms related to race, ethnicity and OASI. Two reviewers will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and Meta-analysis of Observational Studies (MOOSE) recommendations. Meta-analysis will be performed using RevMan for dichotomous data using the random effects model and the odds ratio (OR) as effect measure with a 95% confidence interval (CI). Subgroup analysis will be performed based on Asian subgroups (e.g., South Asian, Filipino, Chinese, Japanese individuals). Study quality assessment will be performed using The Joanna Briggs Institute Critical Appraisal tools.
Discussion:
The systematic review and meta-analysis that this protocol outlines will synthesize the extant literature to better estimate the rates of OASI in Asian and white populations in non-Asian, high-income settings and the relative risk of OASI between these two groups. This systematic summary of the evidence will inform the discrepancy in health outcomes experienced by Asian and white birthing individuals. If these findings suggest a disproportionate burden among Asians, they will be used to advocate for future studies to explore the causal mechanisms underlying this relationship, such as differential care provision, barriers to accessing care, and social and institutional racism. Ultimately, the findings of this review can be used to frame obstetric care guidelines and inform healthcare practices to ensure care that is equitable and accessible to diverse populations.
