基于改良 Robson 分类的中国人口迁移状况与剖宫产的关系。
Association between migration status and caesarean section delivery based on a modified Robson classification in China.
机构信息
The Women and Children's Health Care Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200000, China.
The Obstetrical Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, P.O. 536 Changle Road, Shanghai, 200042, China.
出版信息
BMC Pregnancy Childbirth. 2021 Mar 17;21(1):215. doi: 10.1186/s12884-021-03708-6.
BACKGROUND
China has one of the highest caesarean section (C-Section) rates in the world. In recent years, China has been experiencing a massive flow of migration due to rapid urbanization. In this study, we aimed to differentiate the rates of C-Section between migrants and residents, and explore any possible factors which may moderate the association between migrant status and C-Section rates.
METHODS
We conducted a retrospective cohort study in Shanghai, China. All deliveries were classified using the modified Robson Classification. The association between women's migrant status and C-Section rates was assessed using the Poisson regression of sandwich estimation, after adjusting for possible factors.
RESULTS
Of the 40,621 women included in the study, 66.9% were residents and 33.1% were internal migrants. The rate of C-Section in migrants was lower than that of residents in all subjects (39.9 and 47.7%) and in group 1 subjects (based on the Robson Classification) using a modified Robson Classification. There was an association between migrant status and caesarean delivery on maternal request that was statistically significant (RR = 0.664, p < 0.001), but the association was weakened after adjusting for such factors as maternal age at delivery (aRR = 0.774, p = 0.02), ethnicity (aRR = 0.753, p < 0.001), health insurance (aRR = 0.755, p < 0.001), and occupation (aRR = 0.747, p = 0.004), but had no significant changes when adjusting for health conditions (aRR = 0.668, p = 0.001) and all considering variables (aRR = 0.697, p = 0.002). In group 1 subjects, the effect of migrant status on maternal requested intrapartum C-Section was also statistically significant (RR = 0.742, p = 0.004).
CONCLUSION
C-Section rates are lower among migrant women than residents, especially on maternal request. The medical practitioners should further reinforce the management of elective C-Section in resident women.
背景
中国的剖宫产率位居世界之首。近年来，由于城市化进程的加快，中国经历了大规模的人口迁移。在这项研究中，我们旨在区分移民和居民之间的剖宫产率，并探讨可能调节移民身份与剖宫产率之间关联的因素。
方法
我们在中国上海进行了一项回顾性队列研究。所有分娩均采用改良 Robson 分类法进行分类。使用 sandwich 估计的泊松回归调整可能的因素后，评估妇女移民身份与剖宫产率之间的关联。
结果
在纳入的 40621 名妇女中，66.9%为居民，33.1%为内部移民。在所有受试者（基于改良 Robson 分类的 39.9%和 47.7%）和组 1 受试者（基于 Robson 分类）中，移民的剖宫产率均低于居民。产妇要求剖宫产的产妇与产妇身份之间存在统计学显著关联（RR=0.664，p<0.001），但在调整产妇分娩年龄（aRR=0.774，p=0.02）、种族（aRR=0.753，p<0.001）、健康保险（aRR=0.755，p<0.001）和职业（aRR=0.747，p=0.004）等因素后，这种关联减弱，但在调整健康状况（aRR=0.668，p=0.001）和所有考虑因素时（aRR=0.697，p=0.002），这种关联没有显著变化。在组 1 受试者中，移民身份对产时产妇要求剖宫产的影响也具有统计学意义（RR=0.742，p=0.004）。
结论
与居民相比，移民女性的剖宫产率较低，尤其是产妇要求剖宫产的情况。医务人员应进一步加强对居民妇女选择性剖宫产的管理。
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