Getahun Darios, Strickland Daniel, Lawrence Jean M, Fassett Michael J, Koebnick Corinna, Jacobsen Steven J
Department of Research and Evaluation, West Los Angeles Medical Center, Kaiser Permanente Southern California, Pasadena, CA, USA.
Am J Obstet Gynecol. 2009 Oct;201(4):422.e1-7. doi: 10.1016/j.ajog.2009.07.062.
To examine trends in primary cesarean deliveries by indications and race/ethnicity.
We examined temporal trends in primary cesarean deliveries from 1991 through 2008 among singleton births (n = 540,953) in Kaiser Permanente Southern California hospitals using information from maternal hospitalizations and infant birth certificates. In addition, relative increases and 95% confidence intervals (CIs) were used to estimate differences in primary cesarean section rates by indication for the earliest (1991-1992) and most recent (2007-2008) periods. Racial/ethnic disparities in primary cesarean deliveries were examined by comparing the relative risks from multiple logistic regression models.
The rate of primary cesarean section among white, African American, Hispanic, and Asian/Pacific Islander women increased by 61.6%, 64.1%, 62.4%, and 70.2%, respectively, between 1991 and 2008. In comparison to the primary cesarean section rate for white women, the rate was 25% (95% confidence interval [CI], 22-29%) higher for African American women, 19% (95% CI, 16-23%) higher for Asian/Pacific Islander women, but 14% (95% CI, 13-16%) lower for Hispanic women. After adjustment for confounding factors, primary cesarean section rates remained significantly higher for African American women but lower for Hispanic women compared with white women. Indication subtypes-specific rates of primary cesarean section varied markedly across race/ethnicity.
We found that the overall primary cesarean section rate has increased over time. In addition, there is a wide variability in rate of indications for primary cesarean section by race/ethnicity.
按指征及种族/族裔研究首次剖宫产分娩的趋势。
我们利用南加州凯撒医疗机构医院产妇住院信息及婴儿出生证明，研究了1991年至2008年单胎分娩（n = 540,953）中首次剖宫产分娩的时间趋势。此外，采用相对增加率及95%置信区间（CI）来估计最早时期（1991 - 1992年）和最近时期（2007 - 2008年）按指征划分的首次剖宫产率差异。通过比较多个逻辑回归模型的相对风险，研究首次剖宫产分娩中的种族/族裔差异。
1991年至2008年间，白人、非裔美国人、西班牙裔及亚裔/太平洋岛民女性的首次剖宫产率分别上升了61.6%、64.1%、62.4%和70.2%。与白人女性的首次剖宫产率相比，非裔美国女性的剖宫产率高25%（95%置信区间[CI]，22 - 29%），亚裔/太平洋岛民女性高19%（95% CI，16 - 23%），但西班牙裔女性低14%（95% CI，13 - 16%）。在对混杂因素进行调整后，与白人女性相比，非裔美国女性的首次剖宫产率仍显著较高，而西班牙裔女性则较低。首次剖宫产指征亚型的特定比率在不同种族/族裔间差异显著。
我们发现首次剖宫产的总体比率随时间有所上升。此外，按种族/族裔划分的首次剖宫产指征比率存在很大差异。
