The influence of both individual and area based socioeconomic status on temporal trends in Caesarean sections in Scotland 1980-2000

Abstract

BackgroundCaesarean section rates have risen over the last 20 years. Elective Caesarean section rates have been shown to be linked to area deprivation in England, women in the most deprived areas were less likely to have an elective section than those in the most affluent areas. We examine whether individual social class, area deprivation or both are related to Caesarean sections in Scotland and investigate changes over time.MethodsRoutine maternity discharge data from live singleton births in Scottish hospitals from three time periods were used; 1980-81 (n = 133,555), 1990-91 (n = 128,933) and 1999-2000 (n = 102,285). Multilevel logistic regression, with 3 levels (births, postcode sector and Health Board) was used to analyse emergency and elective Caesareans separately; analysis was further stratified by previous Caesarean section. The relative index of inequality (RII) was used to assess socioeconomic inequalities.ResultsBetween 1980-81 and 1999-2000 the emergency section rate increased from 6.3% to 11.9% and the elective rate from 3.6% to 5.5%. In 1980-81 and 1990-91 emergency Caesareans were more likely among women at the bottom of the social class hierarchy compared to those at the top (RII = 1.14, 95%CI 1.00-1.25 and RII = 1.13, 1.03-1.23 respectively) and also among women in the most deprived areas compared to those in the most affluent (RII = 1.18, 1.05-1.32 and RII = 1.13, 1.02-1.26 respectively). In 1999-2000 the odds of an elective section were lower for women at the bottom of the social class hierarchy than those at the top (RII = 0.87, 0.76-1.00) and also lower in women in the most deprived areas compared to those in the most affluent (RII = 0.85, 0.73-0.99).ConclusionsBoth individual social class and area deprivation are independently associated with Caesarean sections in Scotland. The tendency for disadvantaged women to be more likely to receive emergency sections disappeared at the same time as the likelihood of advantaged groups receiving elective sections increased.

Do psychological factors predict caesarean delivery in Australia? A cohort study

“…The findings support previous research showing an association between pregnancy and social factors and rates of CS [9][10][11][12]18,19]. We found that the father's occupation was associated with CS -families with fathers in unskilled occupations were less likely to undergo CS.…”

“…The strongest of these include increased maternal age, particularly at the time of first birth [9][10][11][12], as well as the mother being overweight or obese [8,13]. In addition, once CS has been performed, the most likely mode of delivery in subsequent pregnancy is CS [14][15][16][17] Higher socio-economic status and possession of private health insurance are also associated with higher rates of CS [18,19].…”

Risk of anal incontinence in women with inflammatory bowel diseases after delivery

“…One of the unclear issues is the impact of childbirth on the development of postpartum incontinence in IBD patients; there is a need to investigate the effects of vaginal delivery on sphincter function, as well as on the development of perianal complications in patients with pre-existing perianal disease adjuvant to Crohn's and in patients with ulcerative colitis. In the last 20 years, statistics show an increase in the prevalence of Caesarean section births (19,(25)(26)(27). Prior studies have demonstrated a higher incidence of Caesarean section births in IBD patients compared to the general population (28,29); this is also seen in our results, where the number of CS births was signifi cantly higher in IBD patients compared to healthy controls.…”

Area deprivation measures used in Brazil

“…This feature demonstrates the utility of the deprivation index as it can be used in situations where the individual-level variables of socioeconomic position are not available or are poorly recorded for certain subgroups (e.g., occupational social class of elderly people who have not worked for a number of years) 9 . Area deprivation measures are also used when individual-level measures are available; individual socioeconomic position and area deprivation can both have an effect on outcomes, independent of each other 15 . Area-based deprivation indicators can be linked to routinely collected administrative data, such as mortality and hospitalizations, where there is typically no information about the socioeconomic position of the individual.…”