Hernández-Vásquez Akram, Chacón-Torrico Horacio, Bendezu-Quispe Guido
Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.
Universidad Científica del Sur, Lima, Peru.
Birth. 2022 Mar;49(1):52-60. doi: 10.1111/birt.12572. Epub 2021 Jul 8.
There is a global concern about the high rates of cesarean birth (CB). This study aimed to investigate the geographic and socioeconomic inequalities in CB rates in the Peruvian population.
We conducted a population-based study using the Peruvian Demographic and Family Health Surveys (ENDES, the Spanish acronym for Encuesta Demográfica y de Salud Familiar) between 2009 and 2018. ENDES reported data from births registered in the five years preceding survey execution. For the years 2009 (n = 10 289) and 2018 (n = 23 077), we calculated the weighted rates of CB among variables such as natural geographic domain (Coast, Andean, or Amazon), area of residence (rural or urban), wealth index quintile (quintile 1 is poorest, and quintile 5 is richest), and educational level. To assess inequalities, we calculated the concentration index (CIs), the slope index of inequality (SII), and the relative index of inequality (RII).
The CB rates by year were 21.4% (95% confidence interval [CI]: 20.0-22.9) in 2009 and 34.5% (95% CI: 33.4-35.5) in 2018. Women living in urban and coastal regions and with a higher education level had the highest CB rates. All the CIs were positive, reflecting a prowealthy inequality in CB rates, and both SII and RII were positive, indicating a gap between the use of cesarean in women in the higher wealth quintile compared with those in the lower quintile.
Cesarean birth rates have increased by 60% during the last decade in Peru. The richest wealth quintiles had the highest CB rates during the study years, which were well above global recommendations.
剖宫产率居高不下已成为全球关注的问题。本研究旨在调查秘鲁人群剖宫产率的地理和社会经济不平等情况。
我们利用2009年至2018年期间的秘鲁人口与家庭健康调查（ENDES，即西班牙语“Encuesta Demográfica y de Salud Familiar”的首字母缩写）开展了一项基于人群的研究。ENDES报告了调查实施前五年内登记的出生数据。对于2009年（n = 10289）和2018年（n = 23077），我们计算了自然地理区域（海岸、安第斯或亚马逊）、居住地区（农村或城市）、财富指数五分位数（五分位数1最贫穷，五分位数5最富有）和教育水平等变量中的剖宫产加权率。为评估不平等情况，我们计算了集中指数（CIs）、不平等斜率指数（SII）和不平等相对指数（RII）。
2009年的剖宫产率为21.4%（95%置信区间[CI]：20.0 - 22.9），2018年为34.5%（95% CI：33.4 - 35.5）。居住在城市和沿海地区且教育水平较高的女性剖宫产率最高。所有的集中指数均为正值，反映出剖宫产率存在有利于富裕人群的不平等现象，不平等斜率指数和不平等相对指数也均为正值，表明财富五分位数较高的女性与较低五分位数的女性在剖宫产使用上存在差距。
秘鲁在过去十年中剖宫产率上升了60%。在研究期间，最富有的财富五分位数人群剖宫产率最高，远高于全球建议水平。
