Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
VA Central Western Massachusetts Healthcare System, Leeds, MA.
Med Care. 2021 Feb 1;59(2):131-138. doi: 10.1097/MLR.0000000000001461.
Racial disparities in maternal morbidity and mortality remain a pressing public health problem. Variations in cesarean section (C-section) rates among racial and ethnic groups have been well documented, though reasons for these variations remain unknown. In the Department of Veterans Affairs (VA), nearly half of all women Veterans are of reproductive age and >40% of these women are racial and ethnic minorities. Because the VA does not provide obstetrical services, all obstetrical care is provided by community obstetrical providers under the auspices of the VA Community Care Network. However, little is known regarding the rates and correlates of C-sections among women Veterans receiving community obstetrical care.
To examine predictors of C-section deliveries among a cohort of racially diverse pregnant Veterans enrolled in VA care at 15 VA medical facilities nationwide.
Cross-sectional analysis of a longitudinal, prospective, multisite, observational cohort study of pregnant, and postpartum Veterans receiving community-based obstetrical care.
Overall, 659 Veterans delivered babies during the study period, and 35% of the deliveries were C-sections. Predictors of C-section receipt included being a woman of color [adjusted odds ratio (AOR), 1.76; 95% confidence interval (CI), 1.19-2.60], having an Edinburgh Postnatal Depression Scale score ≥10 (AOR, 1.71; 95% CI, 1.11-2.65), having a higher body mass indexes (AOR, 1.07; 95% CI, 1.04-1.11), and women who were older (AOR, 1.08; 95% CI, 1.03-1.13). There was a substantial racial variation in C-section rates across our 15 study sites, with C-section rates meeting or exceeding 50% for WOC in 8 study sites.
There is substantial racial and geographic variation in C-section rates among pregnant Veterans receiving obstetrical care through VA community care providers. Future research should carefully examine variations in C-sections by the hospital, and which providers and hospitals are included in VA contracts. There should also be an increased focus on the types of providers women Veterans have access to for obstetrical care paid for by the VA and the quality of care delivered by those providers.
孕产妇发病率和死亡率方面的种族差异仍然是一个紧迫的公共卫生问题。不同种族和族裔群体的剖宫产率差异已有充分记录，尽管造成这种差异的原因尚不清楚。在退伍军人事务部（VA），近一半的女性退伍军人处于生育年龄，其中>40%是少数族裔。由于 VA 不提供产科服务，所有产科护理均由社区产科提供者在 VA 社区护理网络的支持下提供。然而，对于在 VA 接受社区产科护理的女性退伍军人中剖宫产率及其相关因素知之甚少。
在全国 15 个 VA 医疗设施的 VA 护理中，对一组不同种族的孕妇退伍军人队列进行剖宫产率的预测因素分析。
对全国范围内 15 个 VA 医疗设施的接受社区为基础的产科护理的孕妇和产后退伍军人进行纵向、前瞻性、多站点、观察性队列研究的横断面分析。
在研究期间，共有 659 名退伍军人分娩，其中 35%为剖宫产。剖宫产的预测因素包括有色人种女性（调整后的优势比（AOR），1.76；95%置信区间（CI），1.19-2.60）、爱丁堡产后抑郁量表评分≥10 分（AOR，1.71；95%CI，1.11-2.65）、较高的体重指数（AOR，1.07；95%CI，1.04-1.11）和年龄较大的女性（AOR，1.08；95%CI，1.03-1.13）。在我们的 15 个研究地点中，剖宫产率存在显著的种族差异，有 8 个研究地点的剖宫产率达到或超过 50%。
在接受 VA 社区护理提供者提供产科护理的孕妇退伍军人中，剖宫产率存在显著的种族和地域差异。未来的研究应仔细检查医院之间的剖宫产率差异，以及哪些提供者和医院被纳入 VA 合同。还应更加关注女性退伍军人获得 VA 支付的产科护理的提供者类型以及这些提供者提供的护理质量。
