Programa de Pós Graduação em Ciências Médicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
Int J Gynaecol Obstet. 2009 Dec;107(3):198-201. doi: 10.1016/j.ijgo.2009.08.017. Epub 2009 Sep 26.
To investigate inequalities in cesarean delivery rates in Brazil according to ethnic group and level of access to hospital delivery.
Cross-sectional analysis of data for primiparous women with singleton deliveries between 2003 and 2004 from the National Information System of Live-Births (6,064,799 live births). Robust Poisson regression modeling was applied to estimate prevalence ratios of cesarean deliveries for ethnic group and level of access to hospital delivery according to residence.
There were 2,438,180 primiparous deliveries and the cesarean rate was 45.8%. Ethnic inequalities in cesarean delivery rates showed lower rates for all ethnic groups compared with white women, with the lowest rates recorded for indigenous women. The association between ethnicity and cesarean delivery was higher in states with lower access to hospital (P<0.001). Multiple regression models showed that this association was, in part, explained by older maternal age and higher levels of education and prenatal care.
Overuse of cesarean delivery and strong evidence of ethnic inequalities in cesarean rates exist in Brazil. The inequalities are greater in states with lower access to hospital and were partially explained by socioeconomic factors and prenatal care, suggesting a misuse of medical technology at birth.
根据种族和获得医院分娩的水平，调查巴西剖宫产率的不平等现象。
对 2003 年至 2004 年全国活产信息系统（6064799 例活产）中初产妇单胎分娩的数据进行横断面分析。采用稳健泊松回归模型，根据居住地估计剖宫产率的种族和获得医院分娩水平的比值比。
共有 2438180 例初产妇分娩，剖宫产率为 45.8%。与白人妇女相比，所有种族的剖宫产率都较低，其中土著妇女的剖宫产率最低。在获得医院分娩机会较低的州，种族与剖宫产之间的关联更高（P<0.001）。多元回归模型显示，这种关联部分是由产妇年龄较大、受教育程度和产前保健水平较高解释的。
巴西存在剖宫产过度使用和剖宫产率存在明显种族不平等的现象。在获得医院分娩机会较低的州，这种不平等现象更为严重，部分原因是社会经济因素和产前保健解释，这表明在分娩时存在医疗技术的不当使用。
