Perinatal Substance Use and the Documentation of Stigmatizing Language in Clinical Notes

Patients with substance use disorders (SUD) experience bias from clinicians when receiving pregnancy care. Stigmatizing language documented in electronic health records is a marker of clinician bias and it can reinforce inequitable care practices.

The purpose of this study was to examine the associations between substance use and stigmatizing language documented in clinical notes from the birth hospitalization.

This was a cross-sectional study of electronic health record data from patients 20 weeks of gestation admitted to labor and birth at two urban hospitals between 2017 and 2019 ( N =19,094). We identified patients with SUD through ICD-10 codes and natural language processing (NLP)-based keyword searches. We employed an NLP algorithm to identify four categories of stigmatizing language in clinical narratives. We conducted multivariable logistic regression and calculated adjusted odds ratios and 95% confidence intervals for each stigmatizing language category.

Approximately 1.5% of patients had a documented SUD. Patients with SUD had higher odds of any stigmatizing language compared with patients without SUD. Patients with SUD also had higher odds of language representing marginalized language/identities and difficult patient categories. There were no significant differences in the unilateral/authoritarian language category between patients with and without SUD.

Patients with SUD were more likely to have stigmatizing language documented by clinicians during labor and birth. Findings underscore the need for clinician training on person-centered language and the implementation of abolitionist approaches to reduce the stigmatization of patients with SUD.