Schaefer Kimberly M, Modest Anna M, Hacker Michele R, Chie Lucy, Connor Yamicia, Golen Toni, Molina Rose L
Harvard Medical School, Boston, MA, USA.
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA.
Matern Child Health J. 2021 Jul;25(7):1110-1117. doi: 10.1007/s10995-021-03129-z. Epub 2021 Apr 27.
While some medical indications for cesarean delivery are clear, subjective provider and patient factors contribute to the rising cesarean delivery rates and marked disparities between racial/ethnic groups. We aimed to determine the association between language preference and risk of primary cesarean delivery.
We conducted a retrospective cohort study of nulliparous, term, singleton, vertex (NTSV) deliveries of patients over 18 years old from 2011-2016 at an academic medical center, supplemented with data from the Massachusetts Department of Public Health. We used modified Poisson regression with robust error variance to calculate risk ratios for cesarean delivery between patients with English language preference and other language preference, with secondary outcomes of Apgar score, maternal readmission, blood transfusion, and NICU admission.
Of the 11,298 patients included, 10.3% reported a preferred language other than English, including Mandarin and Cantonese (61.7%), Portuguese (9.7%), and Spanish (7.5%). The adjusted risk ratio for cesarean delivery among patients with a language preference other than English was 0.85 (95% CI 0.72-0.997; p = 0.046) compared to patients with English language preference. No significant differences in risk of secondary outcomes between English and other language preference were found.
After adjusting for confounders, this analysis demonstrates a decreased risk of cesarean delivery among women who do not have an English language preference at one institution. This disparity in cesarean delivery rates in an NTSV population warrants future research, raising the question of what clinical and social factors may be contributing to these lower cesarean delivery rates.
虽然剖宫产的一些医学指征很明确，但医生和患者的主观因素导致了剖宫产率的上升以及种族/族裔群体之间的显著差异。我们旨在确定语言偏好与首次剖宫产风险之间的关联。
我们对2011年至2016年在一家学术医疗中心的18岁以上未生育、足月、单胎、头位（NTSV）分娩的患者进行了一项回顾性队列研究，并补充了马萨诸塞州公共卫生部的数据。我们使用具有稳健误差方差的修正泊松回归来计算英语偏好患者与其他语言偏好患者剖宫产的风险比，并将阿氏评分、产妇再次入院、输血和新生儿重症监护病房（NICU）入院作为次要结局。
在纳入的11298名患者中，10.3%报告其偏好的语言不是英语，包括普通话和粤语（61.7%）、葡萄牙语（9.7%）和西班牙语（7.5%）。与英语偏好患者相比，语言偏好非英语的患者剖宫产的调整后风险比为0.85（95%CI 0.72 - 0.997；p = 0.046）。英语和其他语言偏好患者在次要结局风险方面未发现显著差异。
在对混杂因素进行调整后，该分析表明在一家机构中，语言偏好非英语的女性剖宫产风险降低。NTSV人群中剖宫产率的这种差异值得未来研究，这引发了一个问题，即哪些临床和社会因素可能导致了这些较低的剖宫产率。
