Racial/ethnic differences in the likelihood of cesarean delivery, California.

Braveman, Paula; Egerter, Susan; Edmonston, Frances; Verdon, Michel

doi:10.2105/ajph.85.5.625

Cited by 137 publications

(96 citation statements)

References 38 publications

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“…Cesarean delivery rates have been shown to differ by race in certain populations. 14 No one has yet studied the patterns of mode of delivery according to race for breech presentation.…”

Section: Introductionmentioning

confidence: 99%

Delivery mode by race for breech presentation in the US

2007

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Objective: To determine if there are differential cesarean delivery rates by race and other socio-demographic factors for women with breech infants.Study Design: We calculated cesarean delivery rates for 186 727 White, African American, Hispanic and Asian women delivering breech singletons with gestational age 26 to 41 weeks born in 1999 and 2000 using data from the National Center for Health Statistics. Multivariable logistic regression was used to determine differences in mode of delivery by race, adjusting for socio-demographic and medical factors.Results: Cesarean rates for breech were >80% in most gestational age groups. In 14 of 18 groups, Whites had higher cesarean delivery rates than African Americans. However, this finding did not persist after risk adjustment. Hispanics were more likely to deliver by cesarean delivery than African Americans and Whites.Conclusion: Breech singleton infants are predominantly born by cesarean delivery. Although African-American women with breech presentation have lower cesarean delivery rates than Whites, this difference is not present after adjusting for socio-demographic and medical factors. Hispanics were more likely to be delivered by cesarean delivery and this difference was amplified after risk adjustment. Asians had slightly lower cesarean rates after risk adjustment, but this varied widely according to Asian subgroup.

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“…Cesarean delivery rates have been shown to differ by race in certain populations. 14 No one has yet studied the patterns of mode of delivery according to race for breech presentation.…”

Section: Introductionmentioning

confidence: 99%

Delivery mode by race for breech presentation in the US

2007

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“…[17][18][19][20][21][22][23][24][27][28] In this study, the perinatal clinical database allowed for a multivariate analysis of the effects of clinical characteristics and complications of pregnancy on the relationship between method of delivery and insurance status. Results from this study suggest that method of delivery, after controlling for maternal sociodemographic and clinical risk factors, was associated with insurance status.…”

Section: Discussionmentioning

confidence: 99%

“…King and Lahiri 17 identified certain socioeconomic factors, such as maternal educational status, ethnicity, and specific characteristics of the hospital, that affected the odds of a vaginal delivery at several hospitals. Braveman et al, 23 in their retrospective review of birth certificates of live births to California residents during 1991, were not able to control for maternal or fetal clinical complications. Clarification of the role insurance coverage may play in method of delivery at a single hospital with known maternal characteristics remains a central tenet to this issue.…”

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confidence: 99%

Rates of Successful Vaginal Delivery after Cesarean for Patients with Private versus Public Insurance

Wagner

Metts

1999

J Perinatol

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OBJECTIVE:To examine the effect of insurance status on method of delivery while controlling for clinical and sociodemographic characteristics of women delivering at a single medical center. STUDY DESIGN:Sociodemographic and clinical characteristics of 878 women, who delivered their infants between 1985 and 1991 at a university hospital, were analyzed. Women were included if their previous infant was delivered by cesarean section and if the current pregnancy was Ն37 weeks' gestation at nonemergent delivery with insurance status clearly specified. The outcome of interest was the rate of successful vaginal births after cesarean (VBAC) delivery by insurance status. RESULTS:The trial of labor rate for the cohort, defined as the rate of VBAC or cesarean deliveries following labor, was 55%; 61% were vaginal deliveries. Significant differences with regard to insurance status and several maternal factors were noted between trial of labor and cesarean section-no labor groups. After controlling for potentially confounding variables, the Medicaid/indigent group was more likely than the privately insured group to undergo a trial of labor (odds ratio, 1.5; 95% confidence interval, 1.1 to 2.4). Of women who underwent a trial of labor, after controlling for other characteristics, the Medicaid/indigent group was more likely than the privately insured group to deliver vaginally (odds ratio, 1.9; 95% confidence interval, 1.1 to 3.2). CONCLUSION:After controlling for other covariables, women with a history of a prior cesarean section with Medicaid/indigent insurance were more likely than privately insured women to attempt a trial of labor, and subsequently, to deliver vaginally, given that a trial of labor was attempted.The single most common surgical procedure among women of childbearing years remains the delivery of an infant by cesarean section. [1][2][3] The National Center for Health Statistics reported that, in 1993, of the estimated 4 million live births, 14.5% were primary and 8% repeat cesareans yielding an overall rate of cesarean delivery of 22.5%, of which 36.5% were repeat cesareans. 3 Cesarean deliveries are potentially lifesaving to the newborn and mother under high-risk conditions. Those performed selectively, however, have long been known to place a woman and her infant at increased risk for morbidity and mortality. 4 -11 Considering the risks and associated medical costs of cesarean deliveries, a Healthy People 2000 objective 12 is to reduce the rate of repeat cesarean section from 91.2 per 100 deliveries in 1987 to no more than 65 per 100 deliveries by the year 2000. Nationally, more women are delivering subsequent offspring vaginally after a previous vaginal birth after cesarean section (VBAC), if there are no contraindications during pregnancy and labor. [13][14][15][16] The VBAC rate, defined as the proportion of VBAC deliveries among all deliveries of women with a history of previous cesarean section, has risen nationally from 3.4% in 1980 to 25.4% in 1993. 3 Studies have shown VBAC to be safe for low-risk...

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“…An alternate explanation may be derived from the findings of other investigators who reported that the presence of certain nonclinical factors such as maternal educational attainment, family income, insurance status and race were associated with increased use of cesarean delivery. [20][21][22] Data regarding the impact of hospital characteristics, physician practice styles and attributes of health care plans on the risk of cesarean delivery are mixed, but do suggest that other nonmedical factors may be associated with delivery mode. [23][24][25] Accordingly, it has been proposed that physician awareness of certain characteristics may contribute to a lower threshold for surgical delivery.…”

Section: Significancementioning

confidence: 99%

“…[23][24][25] Accordingly, it has been proposed that physician awareness of certain characteristics may contribute to a lower threshold for surgical delivery. 22,26 This investigation is limited by the finite set of variables available on vital records for secondary analysis. As such, we were unable to separately assess elective and indicated cesarean deliveries and/or those with and without a trial of labor.…”

Section: Significancementioning

confidence: 99%