Language-Based Inequities in Transfusion Practices with Obstetric Hemorrhage

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Health Services Research

Background:

• Existing research highlights racial, ethnic, and socioeconomic disparities in postpartum hemorrhage (PPH) outcomes.
• The impact of language barriers on maternal outcomes in PPH remains understudied.
• Investigating language-based inequities is crucial for addressing disparities in maternal care.

Purpose of the Study:

• To examine language-based disparities in maternal outcomes among individuals experiencing PPH.
• To compare transfusion rates and other severe outcomes between English primary language (EPL) and non-English primary language (NEPL) patients with PPH.

Main Methods:

• Retrospective cohort study of PPH patients at an urban academic institution (January 2020 - December 2022).
• Maternal language categorized as English primary language (EPL) or non-English primary language (NEPL).
• Multivariable logistic regression used to analyze the association between primary language and outcomes, adjusting for covariates.

Main Results:

• 1723 PPH patients included: 76.3% EPL, 23.7% NEPL.
• Similar quantitative blood loss (QBL) between EPL and NEPL groups.
• NEPL patients had significantly lower rates of packed red blood cell (pRBC) transfusion (22.9% vs. 28.2%, p=0.039).
• Adjusted analysis showed NEPL patients were less likely to receive transfusions (aOR 0.7, p=0.04).
• Rates of disseminated intravascular coagulation (DIC), ICU admission, and massive transfusion (4+ units pRBC) were similar between groups.

Conclusions:

• Patients with a non-English primary language experiencing PPH received fewer blood transfusions compared to English-speaking patients, despite similar blood loss.
• Language barriers may impede access to necessary interventions like blood transfusions for PPH.
• Further research into health literacy and language proficiency is needed to understand and address these transfusion disparities.