Gould J B, Davey B, Stafford R S
Maternal and Child Health Program, University of California, Berkeley 94720.
N Engl J Med. 1989 Jul 27;321(4):233-9. doi: 10.1056/NEJM198907273210406.
Increasing cesarean-section rates have focused attention on variations in the use of this procedure that appear to be independent of medical indication. We investigated the relation between the rate of primary cesarean section and socioeconomic status in a cohort of 245,854 singleton infants born to non-Hispanic white, black, Asian-American, and Mexican-American residents of Los Angeles County, California. On the basis of birth-certificate data for 1982 and 1983, a significant relation, independent of maternal age, parity, or birth weight, was found between the rates of primary cesarean section and socioeconomic status. Women who lived in census tracts with a median family income of more than $30,000 had a primary cesarean-section rate of 22.9 percent, as compared with 13.2 percent among women residing in areas with a median family income under $11,000. In women between the ages of 18 and 34, the incidence of reported complications of pregnancy or childbirth in the lowest-income group was 10.9 percent, as compared with 17.4 percent in the highest-income group (accounting for 42 percent of the difference in the rate of primary cesarean section between groups); the rate of primary cesarean section in the presence of complications in these two groups was 65.4 percent and 79.3 percent (accounting for 17 percent of the difference); and the primary rate in the absence of reported complications in these two groups was 6.4 percent and 10.5 percent (accounting for 41 percent of the difference). The rates of primary cesarean section were highest among non-Hispanic whites (20.6 percent), intermediate among Asian Americans (19.2 percent) and blacks (18.9 percent), and lowest among Mexican Americans (13.9 percent). Significant socioeconomic differences in these rates were observed in all four groups (P less than 0.01). We conclude that the rates of primary cesarean section vary directly with socioeconomic status and that this association cannot be accounted for by differences in maternal age, parity, birth weight, race, ethnic group, or complications of pregnancy or childbirth.
剖宫产率的不断上升使人们将注意力集中在该手术使用情况的差异上，这些差异似乎与医学指征无关。我们对加利福尼亚州洛杉矶县245,854名单胎婴儿进行了队列研究，调查初产妇剖宫产率与社会经济地位之间的关系，这些婴儿的母亲为非西班牙裔白人、黑人、亚裔美国人和墨西哥裔美国人。根据1982年和1983年的出生证明数据，发现初产妇剖宫产率与社会经济地位之间存在显著关系，且不受产妇年龄、胎次或出生体重的影响。居住在家庭收入中位数超过30,000美元的普查区的妇女，其初产妇剖宫产率为22.9%，而居住在家庭收入中位数低于11,000美元地区的妇女，这一比例为13.2%。在18至34岁的妇女中，收入最低组报告的妊娠或分娩并发症发生率为10.9%，而收入最高组为17.4%（占两组初产妇剖宫产率差异的42%）；这两组出现并发症时的初产妇剖宫产率分别为65.4%和79.3%（占差异的17%）；这两组未报告并发症时的初产妇剖宫产率分别为6.4%和10.5%（占差异的41%）。初产妇剖宫产率在非西班牙裔白人中最高（20.6%），在亚裔美国人和黑人中居中（分别为19.2%和18.9%），在墨西哥裔美国人中最低（13.9%）。在所有四组中均观察到这些比率存在显著的社会经济差异（P<0.01）。我们得出结论，初产妇剖宫产率与社会经济地位直接相关，而且这种关联不能用产妇年龄、胎次、出生体重、种族、族裔群体或妊娠或分娩并发症的差异来解释。
