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Association of Race and Ethnicity as Risk Factors for OASIs: A Systematic Review
Tsung Mou1, Sebastian Ramos2, Evelyn Hall1
1Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery.
Urogynecology (Philadelphia, Pa.)
|January 27, 2026
Summary
Asian American and Pacific Islander individuals face higher odds of obstetric anal sphincter injuries (OASIs). Studies often overlook systemic factors and underrepresent minority groups, hindering efforts to address maternal health disparities.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Health Disparities Research
Background:
- Obstetric anal sphincter injuries (OASIs) are a significant concern in maternal health.
- Understanding how race and ethnicity influence OASI risk is crucial for addressing health disparities.
Purpose of the Study:
- To systematically review and meta-analyze the association between race/ethnicity and OASI incidence.
- To critique the contextualization of race/ethnicity as risk factors in OASI research.
Main Methods:
- Systematic review of observational studies reporting OASI incidence by race and ethnicity.
- Meta-analysis using a random effects model to calculate odds ratios (OR).
- Representation quotient (RQ) analysis for racial representation and equity rubric for critique.
Main Results:
- Asian American and Pacific Islander (AAPI) individuals showed the highest OASI incidence (5.69%) and 61% higher odds compared to White individuals.
- Native American, Black, and Hispanic individuals were underrepresented in the reviewed studies (RQ 0, 0.15, 0.20 respectively).
- Most studies failed to disaggregate AAPI data, address systemic factors (33%), or inappropriately suggested biological differences (22%).
Conclusions:
- AAPI individuals experience significantly higher odds of OASIs.
- Existing research often aggregates data, underrepresents populations, and overlooks critical system-level factors contributing to racial disparities in OASI incidence.
- Improved methodologies are needed to accurately assess and address racial disparities in OASI.
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