Socioeconomic status and receipt of obstetric services in Canada.

OBJECTIVE

To examine differences in labor induction and cesarean delivery rates by socioeconomic status in Nova Scotia, Canada.

METHODS

We studied all women in Nova Scotia who delivered between 1988 and 1995 after a singleton pregnancy. Information was obtained from the Nova Scotia Atlee Perinatal Database and the federal income tax (T1) Family Files maintained by the Small Area and Administrative Data Division of Statistics Canada (n = 76,440). Labor induction and cesarean delivery rates were contrasted by family income and other indices, with adjustment for risk factors carried out using logistic models.

RESULTS

Maternal characteristics and other factors varied by socioeconomic status; in the lowest income group 4.4% of women were aged 35 years or older, and 49.4% were nonsmokers, whereas in the highest income group 17.7% were aged 35 years or older, and 88.7% were nonsmokers. Crude induction rates were similar across income groups (17.7% compared with 18.1% in the lowest compared with highest income groups), but there were significant differences in crude cesarean (17.7% compared with 21.2%) and crude primary cesarean rates (12.5% compared with 17.0%). Controlling for differences in risk factors altered these relationships. Adjusted rate ratios, 95% confidence intervals (CIs) and P values contrasting the lowest compared with highest income groups were labor induction 1.09 (95% CI 1.00-1.19), P = .05; overall cesarean delivery 1.12 (95% CI 1.03-1.23), P = .01; primary cesarean delivery 1.09 (95% CI 0.98-1.21), P = .12.

CONCLUSION

Affluent women in Canada are not more likely to have labor induction or cesarean delivery compared with less affluent women.

LEVEL OF EVIDENCE

II-2.