Differences in caesarean rates across women's socio‐economic status by diverse obstetric indications: Cross‐sectional study

Adhikari, Kamala; McNeil, Deborah; McDonald, Sheila; Patel, Alka; Metcalfe, Amy

doi:10.1111/ppe.12484

Cited by 10 publications

(14 citation statements)

References 32 publications

(77 reference statements)

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“…In addition, the odds of black women getting a C-section were significantly higher compared to white women (OR = 1.03, p<0.01). The associations between the mother’s sociodemographic characteristics and the likelihood of getting a C-section were consistent with previous studies [ 16 , 27 ]. Type II diabetes and hypertension were amongst the strongest individual-level clinical predictors of the likelihood of getting a C-section.…”

Section: Resultssupporting

confidence: 91%

Estimating the differences in Caesarean section (C-section) rates between public and privately insured mothers in Florida: A decomposition approach

et al. 2022

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Background Caesarean section (C-sections) is a medically critical and often life-saving procedure for prevention of childbirth complications. However, there are reports of its overuse, especially in women covered by private insurance as compared to public insurance. This study evaluates the difference in C-Section rates among nulliparous women in Florida hospitals across insurance groups and quantifies the contribution of maternal and hospital factors in explaining the difference in rates. Methods We used Florida’s inpatient data provided by the Florida Agency for HealthCare Administration (FLAHCA) and focused on low-risk births that occurred between January 1, 2010, and September 30, 2015. A Fairlie decomposition method was performed on cross-sectional data to decompose the difference in C-Section rates between insurance groups into the proportion explained versus unexplained by the differences in observable maternal and hospital factors. Results Of the 386,612 NTSV low-risk births, 72,984 were delivered via C-Section (18.87%). Higher prevalence of C-section at maternal level was associated with diabetes, hypertension, and the expectant mother being over 35 years old. Higher prevalence of C-section at the hospital level was associated with lower occupancy rate, presence of neonatal ICU (NICU) unit and higher obstetrics care level in the hospital. Private insurance coverage in expectant mothers is associated with C-section rates that were 4.4 percentage points higher as compared to that of public insurance. Just over 33.7% of the 4.4 percentage point difference in C-section rates between the two insurance groups can be accounted for by maternal and hospital factors. Conclusions The study identifies that the prevalence of C-sections in expectant mothers covered by private insurance is higher compared to mothers covered by public insurance. Although, majority of the difference in C-Section rates across insurance groups remains unexplained (around 66.3%), the main contributor that explains the other 33.7% is advancing maternal age and socioeconomic status of the expectant mother. Further investigation to explore additional factors that explain the difference needs to be done if United States wants to target specific policies to lower overall C-Section rate.

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Section: Resultssupporting

confidence: 91%

Estimating the differences in Caesarean section (C-section) rates between public and privately insured mothers in Florida: A decomposition approach

et al. 2022

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“…In our study, area-level deprivation was significantly associated with perinatal outcomes, but not always in the expected direction: While the ORs of preterm deliveries, SGA births and primary CS were increased in highly deprived regions, similar to previous studies from the United States [9] and Sweden [11], decreased risks of all other outcomes (stillbirths, secondary CS and low Apgar scores) were observed in highly deprived areas. This could make sense with respect to CS rates, which are known to be higher in mothers with high SES [29], although the observation of higher primary CS rates (conducted prior to onset of Labour) and of lower secondary CS rates (conducted after the onset of Labour) in highly deprived regions was somewhat contrary to our expectations. We were also surprised about the finding of lower risks of stillbirths and low Apgar scores in deprived Bavarian areas, which is also contrary to previous studies indicating increased risks for both outcomes in other European countries [30,31].…”

Section: Discussioncontrasting

confidence: 99%

“…This could make sense with respect to CS rates, which are known to be higher in mothers with high SES [ 29 ], although the observation of higher primary CS rates (conducted prior to onset of Labour) and of lower secondary CS rates (conducted after the onset of Labour) in highly deprived regions was somewhat contrary to our expectations. We were also surprised about the finding of lower risks of stillbirths and low Apgar scores in deprived Bavarian areas, which is also contrary to previous studies indicating increased risks for both outcomes in other European countries [ 30 , 31 ].…”

Section: Discussioncontrasting

confidence: 97%

Associations of area-level deprivation with adverse obstetric and perinatal outcomes in Bavaria, Germany: Results from a cross-sectional study

2020

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Background We investigated associations of area-level deprivation with obstetric and perinatal outcomes in a large population-based routine dataset. Methods We used the data of n = 827,105 deliveries who were born in hospitals between 2009 to 2016 in Bavaria, Germany. The Bavarian Index of Multiple Deprivation (BIMD) on district level was assigned to each mother by the zip code of her residential address. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for preterm deliveries, Caesarian sections (CS), stillbirths, small for gestational age (SGA) births and low 5-minute Apgar scores by BIMD quintiles with and without adjustment for potential confounders. Results We observed a significantly increased risk for preterm deliveries in mothers from the most deprived compared to the least deprived districts (e.g. OR [95% CI] for highest compared to lowest deprivation quintile: 1.06 [1.03, 1.09]) in adjusted analyses. Increased deprivation was also associated with higher SGA and secondary CS rates, but with lower proportions of stillbirths, primary CS and low Apgar scores. When one large clinic with an unusually high stillbirth rate was excluded, the association of BIMD with stillbirths was attenuated and almost disappeared. Conclusions We found that area-level deprivation in Bavaria was positively associated with preterm and SGA births, confirming previous studies. In contrast, the finding of an inverse association between deprivation and both stillbirth rates and low Apgar score came somewhat

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“…[ 19 ] We examined whether indicators of maternal agency, a concept that encompasses a sense of women’s control and autonomy, [ 20 , 21 ] differed by type of payer during prenatal, intrapartum and postpartum periods. Research comparing care of women with Medicaid and commercial coverage for maternity care generally reports on differences in use of interventions, with Medicaid beneficiaries less likely to experience cesarean birth overall, [ 22 – 25 ] or for specific diagnoses [ 26 ] or in one study experiencing no difference. [ 27 ] Mothers with Medicaid coverage have been found more likely to experience several indicators of support for vaginal birth after cesarean (VBAC).…”

Section: Introductionmentioning

confidence: 99%

Women’s experience of agency and respect in maternity care by type of insurance in California

2020

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Differences in caesarean rates across women's socio‐economic status by diverse obstetric indications: Cross‐sectional study

Abstract: Examining the overall caesarean rate obscures the relationship between SES and the use of caesarean for particular obstetric-indications. The unequal utilisation of caesareans across SES highlights overuse and potential underuse of the caesareans among American women.

Cited by 10 publications

References 32 publications

Estimating the differences in Caesarean section (C-section) rates between public and privately insured mothers in Florida: A decomposition approach

Estimating the differences in Caesarean section (C-section) rates between public and privately insured mothers in Florida: A decomposition approach

Associations of area-level deprivation with adverse obstetric and perinatal outcomes in Bavaria, Germany: Results from a cross-sectional study

Women’s experience of agency and respect in maternity care by type of insurance in California

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