Delafield Rebecca, Elia Jennifer, Chang Ann, Kaneshiro Bliss, Sentell Tetine, Pirkle Catherine M
Thompson School of Social Work & Public Health, Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI 96822, USA.
John A. Burns School of Medicine, Department of Obstetrics, Gynecology and Women's Health, University of Hawai'i, Honolulu, HI 96826, USA.
Healthcare (Basel). 2021 Feb 3;9(2):159. doi: 10.3390/healthcare9020159.
(1) Background: There are persistent racial/ethnic disparities in cesarean delivery in the United States (U.S.), yet the causes remain unknown. One factor could be provider bias. We examined medical indications for cesarean delivery that involve a greater degree of physician discretion (more subjective) versus medical indications that involve less physician discretion (more objective) to better understand factors contributing to the higher rate among Micronesian, one of the most recent migrant groups in the state, compared to White women in Hawai'i. (2) Methods: A retrospective chart review was conducted to collect data on 620 cesarean deliveries (N = 296 White and N = 324 Micronesian) at the state's largest maternity hospital. Multivariate regression models were used to examine associations between maternal and obstetric characteristics and (1) subjective indication defined as non-reassuring fetal heart tracing (NRFHT) and arrest of labor disorders, and (2) objective indication defined as all other indications (e.g., malpresentation). (3) Results: We found that Micronesian women had significantly higher odds of cesarean delivery due to a subjective indication compared to White women (aOR: 4.17; CI: 2.52-6.88; < 0.001; N = 619) after adjusting for multiple covariates. (4) Conclusion: These findings suggest unmeasured factors, possibly provider bias, may influence cesarean delivery recommendations for Micronesian women in Hawai'i.
（1）背景：在美国，剖宫产方面存在持续的种族/族裔差异，但其原因尚不清楚。一个因素可能是医疗服务提供者的偏见。我们研究了剖宫产的医学指征，其中涉及医生更大程度自由裁量权（更主观）的指征与涉及医生较少自由裁量权（更客观）的指征，以便更好地理解导致该州最新移民群体之一密克罗尼西亚人剖宫产率高于夏威夷白人女性的因素。（2）方法：对该州最大的妇产医院620例剖宫产病例（N = 296例白人，N = 324例密克罗尼西亚人）进行回顾性病历审查以收集数据。使用多变量回归模型来研究孕产妇和产科特征与（1）定义为胎儿心率异常（NRFHT）和产程停滞障碍的主观指征，以及（2）定义为所有其他指征（如胎位异常）的客观指征之间的关联。（3）结果：在调整多个协变量后，我们发现与白人女性相比，密克罗尼西亚女性因主观指征进行剖宫产的几率显著更高（调整后比值比：4.17；可信区间：2.52 - 6.88；P < 0.001；N = 619）。（4）结论：这些发现表明，未测量的因素，可能是医疗服务提供者的偏见，可能会影响对夏威夷密克罗尼西亚女性的剖宫产建议。
