Min Caroline J, Ehrenthal Deborah B, Strobino Donna M
Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE.
Am J Obstet Gynecol. 2015 Jun;212(6):814.e1-814.e14. doi: 10.1016/j.ajog.2015.01.029. Epub 2015 Jan 28.
The objective of the study was to investigate differences in sociodemographic, medical, and obstetric risk factors for primary cesarean delivery between black and white women.
We conducted a retrospective cohort study among 25,251 black and white women delivering a live, singleton infant with vertex presentation at a large, regional hospital between 2004 and 2010. Demographic and clinical data were derived from electronic hospital records. Differences in risk factors for primary cesarean delivery were analyzed using a modified Poisson regression approach stratified by race and parity.
Black and white women had a primary cesarean delivery rate of 24.7% and 22.2%, respectively (P < .001). Black women had an increased risk of cesarean delivery after adjusting for sociodemographic and clinical risk factors (adjusted relative risk [RR], 1.23; 95% confidence interval [CI], 1.17-1.29). Among nulliparas, labor induction had a greater effect on cesarean delivery for black women (adjusted RR, 1.32; 95% CI, 1.20-1.44) than for white women (adjusted RR, 1.13; 95% CI, 1.07-1.20). Among multiparas, labor induction reduced the risk of cesarean delivery for white women (adjusted RR, 0.63; 95% CI, 0.55-0.72), whereas no association was observed for black women (adjusted RR, 1.08; 95% CI, 0.92-1.28). Advanced maternal age was a stronger risk factor for black women (adjusted RR, 1.72; 95% CI, 1.43-2.08) than for white women (adjusted RR, 1.30; 95% CI, 1.11-1.52) among multiparas only. Among nulliparas, delivery at 37-38 weeks' gestation reduced the risk of cesarean delivery for black women (adjusted RR, 0.82; 95% CI, 0.73-0.92), whereas no association was observed for white women (adjusted RR, 0.96; 95% CI, 0.90-1.04).
Labor induction, among nulliparous women, and advanced maternal age, among multiparous women, are stronger risk factors for primary cesarean delivery for black women than for white women.
本研究的目的是调查黑人和白人女性在初次剖宫产的社会人口学、医学和产科风险因素方面的差异。
我们对2004年至2010年间在一家大型地区医院分娩活产单胎头位婴儿的25251名黑人和白人女性进行了一项回顾性队列研究。人口统计学和临床数据来自电子医院记录。使用按种族和胎次分层的改良泊松回归方法分析初次剖宫产风险因素的差异。
黑人和白人女性的初次剖宫产率分别为24.7%和22.2%（P <.001）。在调整社会人口学和临床风险因素后，黑人女性剖宫产的风险增加（调整后相对风险[RR]，1.23；95%置信区间[CI]，1.17 - 1.29）。在初产妇中，引产对黑人女性剖宫产的影响（调整后RR，1.32；95%CI，1.20 - 1.44）大于白人女性（调整后RR，1.13；95%CI，1.07 - 1.20）。在经产妇中，引产降低了白人女性剖宫产的风险（调整后RR，0.63；95%CI，0.55 - 0.72），而黑人女性未观察到相关性（调整后RR，1.08；95%CI，0.92 - 1.28）。仅在经产妇中，高龄产妇对黑人女性（调整后RR，1.72；95%CI，1.43 - 2.08）来说是比白人女性（调整后RR，1.30；95%CI，1.11 - 1.52）更强的风险因素。在初产妇中，孕37 - 38周分娩降低了黑人女性剖宫产的风险（调整后RR，0.82；95%CI，0.73 - 0.92），而白人女性未观察到相关性（调整后RR，0.96；95%CI，0.90 - 1.04）。
初产妇中的引产和经产妇中的高龄产妇，对黑人女性初次剖宫产来说是比白人女性更强的风险因素。
