Jill A. McDonald (
Anup Amatya is an associate professor in the Department of Public Health Sciences; is a member of the Biostatistics and Epidemiology Research Design Core of the Mountain West Idea Clinical and Translational Research-Infrastructure Network (CTR-IN); and is affiliated with the Southwest Institute for Health Disparities Research, College of Health and Social Services, New Mexico State University.
Health Aff (Millwood). 2019 Feb;38(2):276-286. doi: 10.1377/hlthaff.2018.05369.
Hispanic women living on the US-Mexico border have had higher cesarean delivery rates than other Hispanic women in the US. Using birth certificate and other data, we compared cesarean rates among Hispanic women living in US border counties with rates among other Hispanic women in border states during 2015. Using linear regression, we also determined which medical, hospital, and sociodemographic characteristics accounted for intercounty variations in rates. In border counties the rates were 38.3 percent for all births, 31.3 percent for low-risk nulliparous mothers, 21.0 percent for primary cesareans, and 94.7 percent for repeat cesareans. In nonborder counties the rates were 30.9 percent, 24.4 percent, 15.1 percent, and 90.5 percent, respectively. Maternal medical characteristics explained over 50 percent of the variation for all cesarean outcomes. Other characteristics that were major contributors to higher cesarean rates included for-profit hospital status, delivery by a physician as opposed to a midwife, and residence in a county with a larger Hispanic fraction of the population. Addressing potentially unnecessary cesareans among Hispanic women on the border will likely require a multicomponent strategy.
居住在美国-墨西哥边境的西班牙裔女性的剖宫产率高于美国其他西班牙裔女性。我们使用出生证明和其他数据，比较了 2015 年居住在美国边境县的西班牙裔女性与边境州其他西班牙裔女性的剖宫产率。我们还使用线性回归确定了哪些医疗、医院和社会人口特征导致了县际剖宫产率的差异。在边境县，所有分娩的剖宫产率为 38.3%，低危初产妇的剖宫产率为 31.3%，初次剖宫产率为 21.0%，重复剖宫产率为 94.7%。在非边境县，这些比率分别为 30.9%、24.4%、15.1%和 90.5%。产妇医疗特征解释了所有剖宫产结果 50%以上的差异。其他导致剖宫产率较高的主要特征包括营利性医院地位、由医生而不是助产士接生，以及居住在西班牙裔人口比例较大的县。要解决边境地区西班牙裔女性中潜在的不必要剖宫产问题，可能需要采取多方面的策略。
