Cesarean Prevalence Rates for Different Races by Maternal Characteristics [20B]

Abstract

INTRODUCTION: Cesarean delivery rates reached a peak in 2009 and most recently have decreased to their lowest rate since 2007. Our goal was to examine if there were differences in rates of decline for each race (White, Black, Hispanic, Asian and American Indian/Alaska Native. METHODS: We conducted a retrospective cohort study of 1,868,948 singleton, non-anomalous, term gestations from 2010 through 2016 who underwent cesarean section. From there, the rates for each race (White, Black, Hispanic, Asian, American Indian and AI/AN) were stratified based on parity and prior cesarean section. Multivariate regression analyses and chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance. RESULTS: White, Hispanic, Asian and AI/AN all have statistically significant decreasing cesarean prevalence rates overtime for nulliparous, multiparous and prior cesarean section gestations. The rates of cesarean section in nulliparous black women however, did not decline (Table 1). Black and Asian gestations overall had higher prevalence rates for cesarean delivery among nulliparous women. AI/AN had the lowest prevalence rates of cesarean delivery in nulliparous gestations of all races (25.3, 24.5, 22.7, 22.9). CONCLUSION: Overall, there is a race disparity in cesarean section rates among nulliparous black women as compared to all other races, which have all shown a decline over time in cesarean section rates. Nulliparous Black and Asian women have an elevated prevalence rate while nulliparous AI/AN had the lowest cesarean delivery rates of all races. Resources should be targeted to reduce the cesarean section rate among nulliparous black women.

Protocol versus practice: Deviations from guidelines in low‐risk twin deliveries in the United States

“…However, research examining the relationship between cesareans and race/ethnicity is inconsistent 43,44 . Several analyses note differences in cesarean rates by race/ethnicity, 45,46 but others find minimal variation 47‐49 or mixed results 50‐53 . ACOG protocols on twin pregnancies do not delineate race‐based recommendations.…”