Faisal-Cury Alexandre, Menezes Paulo Rossi, Quayle Julieta, Santiago Kely, Matijasevich Alicia
Departamento de Medicina Preventiva. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil.
Rev Saude Publica. 2017 Mar 23;51(0):14. doi: 10.1590/S1518-8787.2017051006134.
To assess the relationship between indicators of socioeconomic status and cesarean section in public hospitals that adopt standardized protocols of obstetrical care.
This was a prospective cohort study conducted between May 2005 and January 2006 with 831 pregnant women recruited from 10 public primary care clinics in São Paulo, Brazil. Demographic and clinical characteristics were collected during pregnancy. The three main exposures were schooling, monthly family income per capita, and residential crowding. The main outcome was cesarean section at three public hospitals located in the area. Crude and adjusted risk ratios (RR), with 95% confidence intervals were calculated using Poisson regression with robust variance. We examined the effects of each exposure variable on cesarean section accounting for potential confounders by using four different models: crude, adjusted by mother's characteristics, by obstetrical complications, and by the other two indicators of socioeconomic status.
Among the 757 deliveries performed in the public hospitals, 215 (28.4%) were by cesarean section. In the bivariate analysis, cesarean section was associated with higher family income per capita, higher education, lower residential crowding, pregnancy planning, white skin color, having a partner, and advanced maternal age. In the multivariate analysis, after adjustment for covariates, none of the socioeconomic status variables remained associated with cesarean section.
In this group, the chance of women undergoing cesarean section was not associated with indicators of socioeconomic status only, but was defined in accordance with major obstetric and clinical conditions.
评估采用标准化产科护理方案的公立医院中社会经济地位指标与剖宫产之间的关系。
这是一项前瞻性队列研究，于2005年5月至2006年1月进行，从巴西圣保罗的10家公立基层医疗诊所招募了831名孕妇。在孕期收集人口统计学和临床特征。三个主要暴露因素为受教育程度、家庭人均月收入和居住拥挤程度。主要结局是该地区三家公立医院的剖宫产情况。使用稳健方差的泊松回归计算粗风险比（RR）和调整风险比（RR）及其95%置信区间。我们通过四种不同模型研究了每个暴露变量对剖宫产的影响，并考虑了潜在混杂因素：粗模型、按母亲特征调整、按产科并发症调整以及按其他两个社会经济地位指标调整。
在公立医院进行的757例分娩中，215例（28.4%）为剖宫产。在双变量分析
