London School of Hygiene and Tropical Medicine, London, UK.
BMJ. 2010 Oct 6;341:c5065. doi: 10.1136/bmj.c5065.
To determine whether the variation in unadjusted rates of caesarean section derived from routine data in NHS trusts in England can be explained by maternal characteristics and clinical risk factors.
A cross sectional analysis using routinely collected hospital episode statistics was performed. A multiple logistic regression model was used to estimate the likelihood of women having a caesarean section given their maternal characteristics (age, ethnicity, parity, and socioeconomic deprivation) and clinical risk factors (previous caesarean section, breech presentation, and fetal distress). Adjusted rates of caesarean section for each NHS trust were produced from this model.
146 English NHS trusts. Population Women aged between 15 and 44 years with a singleton birth between 1 January and 31 December 2008.
Rate of caesarean sections per 100 births (live or stillborn).
Among 620 604 singleton births, 147 726 (23.8%) were delivered by caesarean section. Women were more likely to have a caesarean section if they had had one previously (70.8%) or had a baby with breech presentation (89.8%). Unadjusted rates of caesarean section among the NHS trusts ranged from 13.6% to 31.9%. Trusts differed in their patient populations, but adjusted rates still ranged from 14.9% to 32.1%. Rates of emergency caesarean section varied between trusts more than rates of elective caesarean section.
Characteristics of women delivering at NHS trusts differ, and comparing unadjusted rates of caesarean section should be avoided. Adjusted rates of caesarean section still vary considerably and attempts to reduce this variation should examine issues linked to emergency caesarean section.
确定在英格兰国民保健制度信托机构中从常规数据得出的未经调整剖宫产率的变化是否可以用产妇特征和临床危险因素来解释。
使用常规收集的医院病例统计数据进行了横断面分析。使用多因素逻辑回归模型来估计给定产妇特征（年龄、种族、产次和社会经济剥夺）和临床危险因素（既往剖宫产、臀位和胎儿窘迫）的妇女行剖宫产的可能性。从该模型中生成每个国民保健制度信托机构的调整后剖宫产率。
146 个英格兰国民保健制度信托机构。人群 15 至 44 岁之间的单胎妊娠，分娩时间为 2008 年 1 月 1 日至 12 月 31 日。
每 100 例分娩的剖宫产率（活产或死产）。
在 620604 例单胎分娩中，有 147726 例（23.8%）行剖宫产。如果产妇曾行过剖宫产（70.8%）或婴儿臀位（89.8%），则更有可能行剖宫产。国民保健制度信托机构之间的剖宫产率未经调整的范围为 13.6%至 31.9%。各信托机构的患者人群存在差异，但调整后的剖宫产率仍在 14.9%至 32.1%之间。各信托机构之间的急诊剖宫产率差异大于选择性剖宫产率。
在国民保健制度信托机构分娩的产妇特征不同，应避免比较未经调整的剖宫产率。尽管调整后的剖宫产率仍存在很大差异，但试图减少这种差异应检查与急诊剖宫产相关的问题。
