在劳动和分娩部门的基于风险因素的药物检测政策中评估偏见和种族主义
Arienne Malekmadani1, Leah Puglisi1, Roman Starikov1
1Scripps Health, San Diego, California; and Friends Research Institute, Baltimore, Maryland.
O&G open
|September 26, 2025
概括
怀孕期间基于风险的药物测试不成比例地影响少数群体和低收入患者,经常向儿童福利服务报告,并很少同意或医疗指示进行测试.
科学领域:
- 产科和妇科 产科和妇科
- 公共卫生 公共卫生
- 健康 公平 卫生 公平
背景情况:
- 医院系统经常采用基于风险因素的政策,在产前护理和分娩期间进行药物测试.
- 之前的研究引起了人们对这些测试协议中潜在偏差的担忧.
研究的目的:
- 在医院系统中评估产前护理和分娩期间药物测试的偏见,利用基于风险因素的政策.
- 在药物测试之前评估患者同意的文件.
主要方法:
- 在2020年1月至2022年6月期间,对超过20,000次分娩进行了回顾性队列研究.
- 图表抽象用于识别测试,患者人口统计和临床因素.
- 倾向性得分匹配和后勤回归用于分析患者特征和测试概率之间的关联.
- 对一小部分患者的同意,指示,结果和儿童福利报告的评估.
主要成果:
- 6.2%的患者接受了药物测试,其中11.3%的测试结果呈阳性.
- 与其他种族群体相比,白人患者的阳性测试结果比率更高.
- 没有发现对测试的文档同意;有限的产前护理是最常见的指示,而不是医疗必要性.
- 超过67%的积极结果导致向儿童福利服务部门报告.
结论:
- 基于风险因素的药物毒理政策似乎不成比例地针对黑人,低收入,单身,公共保险和无保险患者.
- 在这种情况下,药物测试往往缺乏患者同意和医疗理由.
- 阳性测试结果通常会导致向儿童福利服务部门报告,突出显著的政策和实践问题.
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