Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, South Korea.
National Health Insurance Service, Wonju, Republic of Korea.
BMC Pregnancy Childbirth. 2019 May 9;19(1):162. doi: 10.1186/s12884-019-2300-0.
Korea is in a condition where the impact of patient and supplier factors on cesarean section rates can be clearly described. The cesarean section rates in Korea are among the highest in the world while the number of obstetricians is decreasing sharply. This study aimed to investigate the geographic variation in cesarean section rates in Korea and its factors.
The data were obtained from the National Health Insurance database in Korea in 2013. We calculated the age-standardized and crude cesarean section rates of 251 districts in Korea and variation statistics. A linear regression analysis was performed to determine factors for cesarean section rates.
The overall cesarean section rate in Korea was 364.6 cases per 1000 live births. The deprivation index score was strongly associated with the increase in the cesarean section rate while the density of hospital obstetricians and hospital beds showed a negative association. Average maternal age and total fertility rate showed a negative relationship with the cesarean section rate.
Korea is suffering from a continuing decrease in obstetricians. Our study shows that this decline has more of an effect on mothers in the disadvantaged areas. Securing equal access to obstetric care among areas is necessary, and measures to encourage obstetricians and mothers not to opt for cesarean section are required.
韩国的情况是，可以清楚地描述患者和供应方因素对剖宫产率的影响。韩国的剖宫产率位居世界前列，而产科医生的数量却在急剧减少。本研究旨在调查韩国剖宫产率的地域差异及其影响因素。
本研究的数据来自韩国 2013 年国家健康保险数据库。我们计算了韩国 251 个区的年龄标准化和粗剖宫产率，并进行了变异统计分析。采用线性回归分析确定剖宫产率的影响因素。
韩国的总剖宫产率为每 1000 例活产 364.6 例。剥夺指数评分与剖宫产率的升高密切相关，而医院产科医生和病床的密度则呈负相关。产妇平均年龄和总生育率与剖宫产率呈负相关。
韩国的产科医生数量持续减少。我们的研究表明，这种下降对弱势地区的产妇影响更大。有必要确保各地区获得平等的产科护理机会，并采取措施鼓励产科医生和产妇避免选择剖宫产。
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