Hueston W J, Lewis-Stevenson S
Department of Family Medicine, Medical University of South Carolina, Charleston 29425, USA.
J Community Health. 2001 Feb;26(1):1-10. doi: 10.1023/a:1026580929659.
Cesarean section rates vary among states from approximately 15% to over 26% of all deliveries. Since it is unlikely that patient factors alone contribute to this wide variation, other non-clinical factors that are unique to each state must influence cesarean section decisions. To explore if provider workforce and specialty was associated with differences in statewide cesarean rates, we compared statewide cesarean rates for 1996 with (1) the volume of deliveries in a state per board-certified obstetrician; (2) percentage of deliveries performed in the state by nurse midwives, and (3) the percentage of family physicians in the state performing obstetrics. In a linear regression model that adjusted for state rurality and median income, we found that only the percentage of family physicians participating in obstetrics was related to cesarean delivery rates. As the percentage of family physicians offering obstetric services increased in a state, the rate of cesarean delivery for that state declined. This effect appeared to be independent of other provider effects, state rurality, or statewide income. Family physician participation in obstetrics is unlikely to be the cause for lower cesarean rates, but is likely a marker for a medical environment and practice style that supports non-operative obstetric care.
剖宫产率在各州之间有所不同，在所有分娩中占比约为15%至超过26%。由于仅患者因素不太可能导致如此大的差异，每个州特有的其他非临床因素必定会影响剖宫产决策。为了探究医疗服务人员数量和专业与全州剖宫产率差异是否相关，我们将1996年的全州剖宫产率与以下因素进行了比较：（1）每个获得委员会认证的产科医生在该州的分娩量；（2）该州由助产士进行的分娩百分比，以及（3）该州从事产科工作的家庭医生百分比。在一个针对州农村地区和收入中位数进行调整的线性回归模型中，我们发现只有从事产科工作的家庭医生百分比与剖宫产率相关。随着一个州提供产科服务的家庭医生百分比增加，该州的剖宫产率下降。这种影响似乎独立于其他医疗服务人员的影响、州农村地区或全州收入。家庭医生参与产科工作不太可能是剖宫产率较低的原因，但很可能是支持非手术产科护理的医疗环境和执业方式的一个标志。
