Patient Disability Status and the Use of Stigmatizing Language in Clinical Notes During Hospital Admission for Birth.
Sarah E Harkins, Ismael I Hulchafo, Jihye Kim Scroggins and 4 others
PMID 40921416WHAT IT FOUND
During birth hospitalization, notes for patients with documented disabilities were more likely to include stigmatizing language, especially wording calling them difficult or centering clinician decisions.
Key findings
01After adjustment, notes for patients with disabilities were significantly more likely to include any stigmatizing language (adjusted odds ratio 1.75, 95% CI 1.47 to 2.09).
02After adjustment, notes for patients with disabilities were significantly more likely to include difficult patient language (adjusted odds ratio 1.96, 95% CI 1.65 to 2.33) and unilateral/authoritarian decision language (adjusted odds ratio 1.27, 95% CI 1.06 to 1.53).
03After adjustment, the difference for marginalized language/identities was not significant (adjusted odds ratio 1.19, 95% CI 0.87 to 1.62).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The findings come from two urban hospitals in the northeastern United States, so they may not apply to birth care in other settings. Disability status was based only on ICD-10 codes in the EHR, so patients without a documented code may have been missed. Only 550 patients had a disability code, so the study could not compare stigmatizing language by disability type. The stigmatizing language was identified by a natural language processing model, not by manual review of every note, and it may have missed nuanced wording. Race and ethnicity data required imputation in the analysis. The study used existing records and did not test whether stigmatizing language changed care or birth outcomes.
Declared interests
The authors reported no conflicts of interest or relevant financial relationships.
The easy way to misread this
Do not conclude that disability status caused stigmatizing documentation or that these notes prove intentional bias. This cross-sectional analysis found an association between coded disability status and stigmatizing language in birth admission notes, and it did not examine whether the language led to worse care or birth outcomes.