Patient Disability Status and the Use of Stigmatizing Language in Clinical Notes During Hospital Admission for Birth

To examine the association between patient disability status and use of stigmatizing language in clinical notes from the hospital admission for birth.

Cross-sectional study of electronic health record data.

Two urban hospitals in the northeastern United States.

Patients at more than 20 weeks gestation admitted for birth from 2017 to 2019 (N = 19,094).

We used a natural language processing algorithm to identify categories of stigmatizing language used in free-text clinical notes (N = 211,841 unique clinical notes). We employed multivariable logistic regression to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for each stigmatizing language category by disability status, which we determined by ICD-10 (International Classification of Diseases, 10th revision) codes.

Approximately 3% of patient records (n = 550) included ICD-10 codes for disability. Clinicians were more likely to use stigmatizing language for patients with disabilities compared with patients without disabilities (aOR = 1.75, 95% CI = [1.47, 2.09]). For patients with disabilities compared with patients without disabilities, clinicians were also more likely to use stigmatizing language in the difficult patient category (aOR = 1.96, 95% CI = [1.65, 2.33]) and the unilateral/authoritarian decisions category (aOR = 1.27, 95% CI = [1.06, 1.53]). We found no significant differences for the marginalized language/identities category by patient disability status (aOR = 1.19, 95% CI = [0.87, 1.62]).

The use of stigmatizing language in birth hospitalization notes differed by patient disability status. Stigmatizing language should be used as a marker of bias and an opportunity for clinicians to reflect on their thoughts, words, and actions. Patient-centered documentation and care practices are needed to improve perinatal health for all.