Freitas Paulo Fontoura, Drachler Maria de Lourdes, Leite José Carlos de Carvalho, Grassi Paulo Recena
Programa de Pós Graduação em Saúde Pública, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
Rev Saude Publica. 2005 Oct;39(5):761-7. doi: 10.1590/s0034-89102005000500010. Epub 2005 Oct 24.
To investigate the effect of social inequalities in cesarean section rates among primiparae having single pregnancy and delivering in maternity hospitals.
The study was carried out in Southern Brazil in 1996, 1998 and 2000. Data from the Live Birth National Information System were used to estimate annual rates and crude and adjusted odds ratios (OR) of cesarean sections according to social conditions (maternal age and education, newborn skin color/ethnicity and macro-regions), duration of pregnancy, and number of prenatal visits.
The overall cesarean section rate was 45%, and above 37% in all macro-regions. Increased rates were seen among native and black mothers, aged 30 years or more, living in metropolitan, river valley and mountain macro-regions and having attended to more than six prenatal visits. Crude and adjusted OR show that cesarean rates were negatively associated with all categories of skin color/ethnicity when compared to white newborns, particularly those of native Brazilian (ORadj=0.43; 95% CI: 0.31-0.59), and they were positively associated with higher maternal education (ORadj=3.52; 95% CI: 3.11-3.99), older age (ORadj=6.87; 95% CI: 5.90-8.00) and greater number of prenatal visits (ORadj=2.16; 95% CI: 1.99-2.35). The effects of age and education were partly mediated by the greater number of prenatal visits among higher educated older women. The OR varied among macro-regions but were greater for the wealthier mountain region.
High rates of cesarean section rates in Southern Brazil are a public health concern. They are associated with social, economic and cultural factors which can lead to misuse of medical technology during labor and delivery.
探讨单胎初产妇在妇产医院剖宫产率方面社会不平等的影响。
该研究于1996年、1998年和2000年在巴西南部开展。利用全国活产信息系统的数据，根据社会状况（产妇年龄和教育程度、新生儿肤色/种族以及大区域）、孕期时长和产前检查次数，估算剖宫产的年发生率以及粗比值比和调整比值比（OR）。
总体剖宫产率为45%，所有大区域均高于37%。在年龄30岁及以上、居住在大都市、河谷和山区大区域且产前检查超过6次的本地和黑人母亲中，剖宫产率有所上升。粗比值比和调整比值比显示，与白人新生儿相比，剖宫产率与所有肤色/种族类别均呈负相关，尤其是巴西本土新生儿（ORadj=0.43；95%置信区间：0.31-0.59），且与产妇较高的教育程度（ORadj=3.52；95%置信区间：3.11-3.99）、较高年龄（ORadj=6.87；95%置信区间：5.90-8.00）和较多的产前检查次数（ORadj=2.16；95%置信区间：1.99-2.35）呈正相关。年龄和教育程度的影响部分由受过高等教育的年长女性产前检查次数较多所介导。比值比在不同大区域有所不同，但在较富裕的山区更高。
巴西南部剖宫产率居高是一个公共卫生问题。它们与社会、经济和文化因素相关，这些因素可能导致分娩过程中医疗技术的滥用。
