{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T14:03:23Z","timestamp":1792159403712,"version":"4.4.0"},"reference-count":34,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T00:00:00Z","timestamp":1746748800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T00:00:00Z","timestamp":1746748800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Racial disparities in obstetric anal sphincter injury (OASI) are poorly understood; their investigation by parity, obstetric history and mode of delivery may provide insight into which individuals are at the greatest risk for OASI. We aimed to quantify the association of race and ethnicity with OASI, stratified by parity, obstetric history and mode of delivery. Secondary aims were to explore variations in OASI rates among racial subgroups and by immigration status (foreign\u2010born\n                      <jats:italic>vs<\/jats:italic>\n                      USA\u2010born).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross\u2010sectional study of 12\u2009501\u2009183 vaginal births in the USA from January 2016 to December 2021 using birth\u2010certificate data obtained from the National Vital Statistics System. Cox proportional hazard regression models were fitted, with gestational age as the timescale, to quantify the association of self\u2010reported race and ethnicity with OASI, with adjustment for several confounders. The maternal race and ethnicity groups included: American Indian or Alaska Native (AIAN), Asian, Black, Hispanic, Native Hawaiian and other Pacific Islander, White and mixed race. Models were stratified by number of previous births and the occurrence of Cesarean delivery (CD) among prior births. This resulted in three groups: primiparous (i.e. only the index birth); multiparous without a previous CD; and multiparous with at least one previous CD. Within each stratum, we further grouped individuals by mode of delivery in the index birth, as spontaneous vaginal delivery\u00a0(SVD), operative vaginal delivery (OVD) with forceps and OVD with vacuum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In primiparous individuals who had a vaginal birth, the overall OASI rate was 2.2%, but it varied widely by mode of delivery (SVD, 1.7%; OVD with forceps, 14.8%; OVD with vacuum, 6.6%). Asian primiparae had higher OASI hazards compared with White primiparae, irrespective of mode of delivery (SVD: adjusted hazard ratio (aHR), 1.69 (95%\u2009CI, 1.64\u20131.73); OVD with forceps: aHR, 1.48 (95%\u2009CI, 1.38\u20131.58); OVD with vacuum: aHR, 1.51 (95%\u2009CI, 1.44\u20131.58)), while AIAN and Black primiparae had inconsistent associations with OASI rate depending on mode of delivery, when compared with White primiparae. In multiparous individuals without a previous CD, the rates of OASI were lower than those seen in primiparae (SVD, 0.5%; OVD with forceps, 7.5%; OVD with vacuum, 3.2%) and the association of race and ethnicity with OASI varied by mode of delivery for all race groups except Asian, in whom it was consistently associated with a 1.5\u20132.1\u2010times higher hazard of OASI. Among multiparous individuals with a previous CD, overall OASI rates were similar to those seen in primiparae (SVD, 1.3%; OVD with forceps, 11.8%; OVD with vacuum, 5.1%). In this group, the only associations of race and ethnicity with OASI were higher hazards among Asian\n                      <jats:italic>vs<\/jats:italic>\n                      White individuals who had a SVD (aHR, 2.16 (95%\u2009CI, 1.97\u20132.36)) and an OVD with vacuum (aHR, 1.65 (95%\u2009CI, 1.39\u20131.96)). The rate of OASI varied widely between Asian race subgroups, with the highest rate noted among individuals with origins and\/or ancestry from India (e.g. 27.2% among primiparae who had OVD with forceps) and the lowest in those from Japan (e.g. 9.3% among primiparae who had OVD with forceps). Across racial and ethnic minority groups, the OASI rate was higher among foreign\u2010born\n                      <jats:italic>v<\/jats:italic>\n                      s USA\u2010born residents; this trend was not observed among White individuals.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Racial and ethnic disparities in OASI persist regardless of parity, obstetric history and mode of delivery. Variations in the OASI rate are apparent within Asian racial subgroups and by immigration status. \u00a9 2025 The Author(s).\n                      <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic>\n                      published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.29231","type":"journal-article","created":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T11:56:03Z","timestamp":1746791763000},"page":"778-789","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Racial and ethnic disparities in obstetric anal sphincter injury: cross\u2010sectional study in the USA"],"prefix":"10.1002","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0931-289X","authenticated-orcid":false,"given":"M.","family":"Rajasingham","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Health Sciences McMaster University  Hamilton ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Hossein\u2010Pour","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Health Sciences McMaster University  Hamilton ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"D'Souza","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Health Sciences McMaster University  Hamilton ON Canada"},{"name":"Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences McMaster University  Hamilton ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Geoffrion","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. V.","family":"Ananth","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences Rutgers Robert Wood Johnson Medical School  New Brunswick NJ USA"},{"name":"Cardiovascular Institute of New Jersey Rutgers Robert Wood Johnson Medical School  New Brunswick NJ USA"},{"name":"Department of Medicine Rutgers Robert Wood Johnson Medical School  New Brunswick NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. M.","family":"Muraca","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Health Sciences McMaster University  Hamilton ON Canada"},{"name":"Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences McMaster University  Hamilton ON Canada"},{"name":"Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,9]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000720"},{"key":"e_1_2_7_3_1","volume-title":"The Management of Third\u2010 and Fourth\u2010Degree Perineal Tears","author":"Royal College of Obstetricians and Gynaecologists","year":"2015"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2024.102719"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.02.041"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/SPV.0000000000000517"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2016.1177719"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xagr.2023.100296"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002444"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31820afaf2"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.17063"},{"key":"e_1_2_7_12_1","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologist.ACOG Practice Bulletin: Operative Vaginal Birth.2020;135(4):e149\u2010e159.","DOI":"10.1097\/AOG.0000000000003764"},{"key":"e_1_2_7_13_1","volume-title":"User Guide to the 2021 Natality Public Use File","author":"National Center for Health Statistics","year":"2021"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.13304"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0001060"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2021.01394"},{"key":"e_1_2_7_17_1","volume-title":"Critical Race Theory: The Key Writings That Formed the Movement","author":"Crenshaw K","year":"1995"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000105"},{"key":"e_1_2_7_19_1","first-page":"29","volume-title":"Guide to Completing the Facility Worksheets for the Certificate of Live Birth and Report of Fetal Death","author":"National Vital Statistics System","year":"2022"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.3194"},{"issue":"1","key":"e_1_2_7_21_1","first-page":"8","article-title":"Associations between maternal obesity and race, with obstetric anal sphincter injury: a retrospective cohort study","volume":"78","author":"Yamasato K","year":"2019","journal-title":"Hawaii J Med Public Health"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k757"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000828"},{"key":"e_1_2_7_24_1","unstructured":"R Core Team.R: A Language and Environment for Statistical Computing.2023https:\/\/www.R\u2010project.org\/."},{"key":"e_1_2_7_25_1","unstructured":"TherneauTM.A Package for Survival Analysis in R.2024https:\/\/CRAN.R\u2010project.org\/package=survival."},{"key":"e_1_2_7_26_1","unstructured":"HaineD.The episensr package: basic sensitivity analysis of epidemiological results.2023https:\/\/dhaine.github.io\/episensr\/."},{"key":"e_1_2_7_27_1","doi-asserted-by":"crossref","unstructured":"vanBuurenS Groothuis\u2010OudshoornK.mice: Multivariate Imputation by Chained Equations in R.2011.","DOI":"10.18637\/jss.v045.i03"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.0003"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0000000000000349"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.srhc.2015.02.005"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16985"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/SPV.0000000000000285"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12557"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.15427"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-024-05966-2"}],"container-title":["Ultrasound in Obstetrics &amp; 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