Cesarean delivery rates for overall and multiple pregnancies in Japan: A descriptive study using nationwide health insurance claims data

Abstract

Aim Due to the lack of national perinatal registries, population‐wide descriptive statistics on cesarean deliveries in Japan are unknown. We aim to describe cesarean deliveries for overall and multiple pregnancies using the Japan National Database of health insurance claims. Methods We calculated the national and prefectural cesarean delivery rates for overall and multiple pregnancies in 2014. We described maternal morbidities (e.g., blood transfusion) and the place and type of the institutions providing prenatal and perinatal care. Results The national cesarean delivery rates were 18.6% overall and 82.7% for women with multiple pregnancies. Prefectural cesarean delivery rates for overall and multiple pregnancies varied from 12.5% to 24.2% and from 49.2% to 100%, respectively, showing a moderate positive correlation (r = 0.59, p < 0.001). Overall, 1.4% of cesarean patients received an allogeneic blood transfusion, compared to 3.2% for those with multiple pregnancies. In addition, 65.9% of overall cesarean deliveries occurred at hospitals with ≥20 beds, whereas 94.6% of cesarean patients with multiple pregnancies delivered at hospitals. Older patients were more likely to receive their cesarean section at a different institution than their first visit within the same prefecture, but trans‐prefectural movement during pregnancy covered by health insurance was most frequent among those in their early thirties: 7.0% overall and 10.7% for multiple pregnancies. Conclusions The overall cesarean delivery rate in Japan was optimal, but the rate was high for multiple pregnancies, with large regional differences. Data on patient movement across institutions and areas would help to improve the perinatal care system.

The validity of claim‐based cesarean deliveries in Japan

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Letter to the EditorThe validity of claim-based cesarean deliveries in Japan Dear Editor, Using the Japan National Database (NDB) of Health Insurance Claims for 2014, we estimated the cesarean delivery rate to be 18.6% for all pregnancies and 82.7% for women with multiple pregnancies. 1 The NDB data for the number of overall and prefectural cesarean cases in September 2014 1 closely matched that of the Medical Institution Survey 2 (intraclass correlation coefficient = 0.996, p < 0.001). However, there were no official data for cesarean deliveries for multiple pregnancies.To evaluate the validity of claim-based cesarean deliveries, including multiple pregnancies, we investigated deliveries in Akita Prefecture.

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