Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford BD96RJ, UK.
BMC Public Health. 2011 May 18;11:330. doi: 10.1186/1471-2458-11-330.
Caesarean section rates have risen over the last 20 years. Elective Caesarean section rates have been shown to be linked to area deprivation in England, women in the most deprived areas were less likely to have an elective section than those in the most affluent areas. We examine whether individual social class, area deprivation or both are related to Caesarean sections in Scotland and investigate changes over time.
Routine maternity discharge data from live singleton births in Scottish hospitals from three time periods were used; 1980-81 (n = 133,555), 1990-91 (n = 128,933) and 1999-2000 (n = 102,285). Multilevel logistic regression, with 3 levels (births, postcode sector and Health Board) was used to analyse emergency and elective Caesareans separately; analysis was further stratified by previous Caesarean section. The relative index of inequality (RII) was used to assess socioeconomic inequalities.
Between 1980-81 and 1999-2000 the emergency section rate increased from 6.3% to 11.9% and the elective rate from 3.6% to 5.5%. In 1980-81 and 1990-91 emergency Caesareans were more likely among women at the bottom of the social class hierarchy compared to those at the top (RII = 1.14, 95%CI 1.00-1.25 and RII = 1.13, 1.03-1.23 respectively) and also among women in the most deprived areas compared to those in the most affluent (RII = 1.18, 1.05-1.32 and RII = 1.13, 1.02-1.26 respectively). In 1999-2000 the odds of an elective section were lower for women at the bottom of the social class hierarchy than those at the top (RII = 0.87, 0.76-1.00) and also lower in women in the most deprived areas compared to those in the most affluent (RII = 0.85, 0.73-0.99).
Both individual social class and area deprivation are independently associated with Caesarean sections in Scotland. The tendency for disadvantaged women to be more likely to receive emergency sections disappeared at the same time as the likelihood of advantaged groups receiving elective sections increased.
在过去的 20 年里，剖宫产率有所上升。在英格兰，择期剖宫产率与地区贫困程度有关，最贫困地区的妇女接受择期剖宫产的可能性低于最富裕地区的妇女。我们研究了个体社会阶层、地区贫困程度或两者是否与苏格兰的剖宫产有关，并调查了随时间的变化。
使用苏格兰医院活单胎分娩的三个时期的常规产妇出院数据；1980-81 年（n=133555）、1990-91 年（n=128933）和 1999-2000 年（n=102285）。使用三级（分娩、邮政编码区和卫生局）多水平逻辑回归分别分析紧急和择期剖宫产；进一步按既往剖宫产分层分析。相对不平等指数（RII）用于评估社会经济不平等。
在 1980-81 年至 1999-2000 年期间，急诊剖宫产率从 6.3%上升至 11.9%，择期剖宫产率从 3.6%上升至 5.5%。在 1980-81 年和 1990-91 年，与社会阶层顶层的女性相比，社会阶层底层的女性更有可能进行紧急剖宫产（RII=1.14，95%CI 1.00-1.25 和 RII=1.13，1.03-1.23），与最贫困地区的女性相比，与最富裕地区的女性相比（RII=1.18，1.05-1.32 和 RII=1.13，1.02-1.26）。在 1999-2000 年，与社会阶层顶层的女性相比，社会阶层底层的女性进行择期剖宫产的可能性较低（RII=0.87，0.76-1.00），与最富裕地区的女性相比，最贫困地区的女性进行择期剖宫产的可能性也较低（RII=0.85，0.73-0.99）。
个体社会阶层和地区贫困程度均与苏格兰的剖宫产独立相关。弱势妇女更有可能接受紧急剖宫产的趋势随着优势群体接受择期剖宫产的可能性增加而消失。
