Racial and Ethnic Differences in Urine Drug Screening on Labor and Delivery

Abstract

Introduction: This study evaluates racial and ethnic differences in urine drug screening and patient consent to urine drug screening at a single tertiary care center.

Methods: We conducted a retrospective cohort study of all deliveries at a single tertiary care center from January 1, 2015 to December 31, 2019. Medical records were queried for demographic data, performance of urine drug screening, commonly used diagnoses that prompted screening, documentation of patient consent, and result of screen. Associations between these outcomes were then assessed using Chi-square analysis and logistic regression.

Results: During the study period, 685 of 9953 (6.9%) of patients had a urine drug screen performed. Non-Hispanic Black patients comprised 33.6% of patients receiving screening, but only 16.6% of the total population. Of examined indications for urine drug screening, only insufficient prenatal care and trauma differed significantly between groups. After adjusting for commonly used diagnoses prompting screening, non-Hispanic black patients were significantly more likely to have urine drug screening performed (OR 2.0, 95% CI 1.6-2.4). Non-Hispanic Black and Hispanic patients were not significantly more likely to have a positive screen result when compared to Non-Hispanic White patients. Consent to urine drug screening was poorly documented (only 11.7% of patients had documented consent). This did not differ significantly between the major racial or ethnic groups.

Conclusion: Non-Hispanic Black and Hispanic patients experience differences in urine drug screening during admission for delivery that cannot be solely explained by differences in incidence of diagnoses that typically trigger screening. Documentation of patient consent to urine drug screening is poor.

Keywords: Pregnancy; Substance use; Urine drug screening.