Maternal education and racial/ethnic disparities in nulliparous, term, singleton, vertex cesarean deliveries in the United States

Eliner, Yael; Gulersen, Moti; Chervenak, Frank A.; Lenchner, Erez; Grünebaum, Amos; Phillips, Kameelah; Bar-El, Liron; Bornstein, Eran

doi:10.1016/j.xagr.2021.100036

Cited by 9 publications

(6 citation statements)

References 73 publications

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“…We found a positive association between mothers having an education status less than or equal to the 10th standard and the risk of CS. Similarly, a study by Eliner et al has shown that women with higher education levels are less likely to have CS than those with lower education levels [ 15 ]. This could be due to several reasons, including the fact that women with higher education levels tend to have more resources and better access to healthcare, which can help them manage their pregnancies better and avoid the need for CS, women with higher education levels may have a better understanding of pregnancy and childbirth, which can help them make informed decisions and communicate effectively with their healthcare providers, and women with higher education levels may be more likely to engage in healthy behaviours such as regular exercise and good nutrition, which can help them have a healthy pregnancy and avoid complications that may require a CS.…”

Section: Discussionmentioning

confidence: 99%

Factors Contributing to Rapidly Increasing Rates of Caesarean Section in Andhra Pradesh, India: A Case-Control Study

B¹,

Desu²,

Aravindakshan³

et al. 2023

Cureus

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In some obstetric situations, a caesarean section (CS) can be a crucial, life-saving treatment for both the mother and the infant. Nonetheless, unnecessary CS can raise the risk of morbidity for both. The present study was conducted to study the factors associated with CS delivery and to study the patterns of utilization of health facilities by pregnant women in the state of Andhra Pradesh in India. Materials and methodsA community-based case-control study was done in Mangalagiri mandal, Guntur district, Andhra Pradesh, India in 2022. A total of 268 mothers (134 CS and 134 normal vaginal childbirth) who delivered between 2019 to 2022 with at least one biological child less than three years of age were studied. The data was collected using a structured questionnaire. Robson's 10-Group Classification was used to differentiate the type of deliveries of the participants. A p-value less than 0.05 was considered to be significant. ResultsThe mean age of the 268 women studied was 25.49±3.73 years. We found that 47 of the 82 (57.3%) women who went to government healthcare facilities and 87 of the 181 (48.1%) women who went to private healthcare facilities had a CS. Of the total CS studied, approximately 83.5% were emergency CSs. All four mothers who had twins had undergone CS. All women with oblique or transverse fetal lie underwent CS irrespective of parity. On multivariate analysis, participants' education status less than or equal to 10th standard was positively associated with CS and identification of complications in the third trimester by healthcare provider was significantly protective for CS. ConclusionCS rate reduction necessitates a multi-faceted strategy that includes a variety of programming initiatives. Audits of CS performed as part of health programs and other creative monitoring techniques can be useful tools for assessing the standard of maternity care, particularly emergency CS.

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Section: Discussionmentioning

confidence: 99%

Factors Contributing to Rapidly Increasing Rates of Caesarean Section in Andhra Pradesh, India: A Case-Control Study

B¹,

Desu²,

Aravindakshan³

et al. 2023

Cureus

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“…Risk factors for placental disorders include a previous cesarean delivery, with each successive cesarean compounding an individual's risk [12]. Given this elevated risk, understanding trends of peripartum hysterectomy among individuals with a previous cesarean delivery is particularly valuable given the growth of this population, which has been shown to be differentially distributed among racial/ethnic groups [13][14][15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Temporal trends in peripartum hysterectomy among individuals with a previous cesarean delivery by race/ethnicity in the United States: A population-based cohort study

Rajasingham,

Hossein Pour,

Scattolon

et al. 2024

PLoS ONE

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Objectives Rates of severe maternal morbidity have highlighted persistent and growing racial disparities in the United States (US). We aimed to contrast temporal trends in peripartum hysterectomy by race/ethnicity and quantify the contribution of changes in maternal and obstetric factors to temporal variations in hysterectomy rates. Methods We conducted a population-based, retrospective study of 5,739,569 US residents with a previous cesarean delivery, using National Vital Statistics System’s Natality Files (2011–2021). Individuals were stratified by self-identified race/ethnicity and classified into four periods based on year of delivery. Temporal changes in hysterectomy rates were estimated using odds ratios (ORs) and 95% confidence intervals (CIs). We used sequential logistic regression models to quantify the contribution of maternal and obstetric factors to temporal variations in hysterectomy rates. Results Over the study period, the peripartum hysterectomy rate increased from 1.23 (2011–2013) to 1.44 (2019–2021) per 1,000 deliveries (OR 2019–2021 vs. 2011–2013 = 1.17, 95% CI 1.10 to 1.25). Hysterectomy rates varied by race/ethnicity with the highest rates among Native Hawaiian and Other Pacific Islander (NHOPI; 2.73 per 1,000 deliveries) and American Indian or Alaskan Native (AIAN; 2.67 per 1,000 deliveries) populations in 2019–2021. Unadjusted models showed a temporal increase in hysterectomy rates among AIAN (2011–2013 rate = 1.43 per 1,000 deliveries; OR 2019–2021 vs. 2011–2013 = 1.87, 95% CI 1.02 to 3.45) and White (2011–2013 rate = 1.13 per 1,000 deliveries; OR 2019–2021 vs. 2011–2013 = 1.21, 95% CI 1.11 to 1.33) populations. Adjustment ranged from having no effect among NHOPI individuals to explaining 14.0% of the observed 21.0% increase in hysterectomy rates among White individuals. Conclusion Nationally, racial disparities in peripartum hysterectomy are evident. Between 2011–2021, the rate of hysterectomy increased; however, this increase was confined to AIAN and White individuals.

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“…In the United States, social determinants of health such as access to insurance, median income, and race/ethnicity influence access to many lifesaving procedures [ 7 ]. Several studies have highlighted these disparities in the incidences of CS [ 8 ]. While studies have highlighted a higher incidence of primary CS among minority groups, there is a need to further explore the interaction of patients’ race/ethnicity and insurance types and how these affect the incidences of CS.…”

Section: Introductionmentioning

confidence: 99%

Disparities in Incidences of Cesarean Section Among Women With Gestational Diabetes Mellitus in the United States

Akinyemi¹,

Lipscombe²,

Omokhodion³

et al. 2022

Cureus

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BackgroundIn this study, we explored the interaction between women's race/ethnicity and insurance type and determined how these interactions affect the incidences of cesarean section (CS) among women with gestational diabetes mellitus (GDM). MethodologyWe utilized the National Inpatient Sample (NIS) database from January 2000 to September 2015 to conduct a retrospective analysis of all GDM-associated hospitalizations. We then explored the interaction between race/ethnicity and insurance types and determined how these interactions affect the incidences of CS among GDM patients, controlling for traditional risk factors for CS and patients' sociodemographics. Subsequently, we determined the risk of primary postpartum hemorrhage (PPH) in the CS group and a propensity scorematched control group who had vaginal deliveries. ResultsThere were 932,431 deliveries diagnosed with GDM in the NIS database from January 2000 to September 2015. The mean age of the study population was 30.6 ± 5.9 years, 44.5% were white, 14.0% were black, and 26.7% were Hispanic. The CS rate was 40.5%. After controlling for covariates, women who utilized private insurance had the highest CS rate across the different races/ethnicities; white (odds ratio (OR) = 1.21 (1.17-1.25)) blacks )), and Hispanic (OR = 1.12 (1.06-1.18)). CS patients were less likely to develop PPH compared to their matched controls with vaginal deliveries (OR = 0.67 (0.63-0.71)). ConclusionsPrivate insurance is associated with higher incidences of CS among women with GDM, irrespective of race/ethnicity.

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Maternal education and racial/ethnic disparities in nulliparous, term, singleton, vertex cesarean deliveries in the United States

Cited by 9 publications

References 73 publications

Factors Contributing to Rapidly Increasing Rates of Caesarean Section in Andhra Pradesh, India: A Case-Control Study

Factors Contributing to Rapidly Increasing Rates of Caesarean Section in Andhra Pradesh, India: A Case-Control Study

Temporal trends in peripartum hysterectomy among individuals with a previous cesarean delivery by race/ethnicity in the United States: A population-based cohort study

Disparities in Incidences of Cesarean Section Among Women With Gestational Diabetes Mellitus in the United States

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