Department of Community Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Obstetrics and Gynecology, Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Valiasr Hospital, Tehran, Iran.
BMC Pregnancy Childbirth. 2022 Nov 6;22(1):821. doi: 10.1186/s12884-022-05133-9.
Caesarean section (C/S) rates have significantly increased across the world over the past decades. In the present population-based study, we sought to evaluate the association between C/S and neonatal mortality rates.
This retrospective ecological study included longitudinal data of 166 countries from 2000 to 2015. We evaluated the association between C/S rates and neonatal mortality rate (NMR), adjusting for total fertility rate, human development index (HDI), gross domestic product (GDP) percentage, and maternal age at first childbearing. The examinations were also performed considering different geographical regions as well as regions with different income levels.
The C/S rate and NMR in the 166 included countries were 19.97% ± 10.56% and 10 ± 10.27 per 1000 live birth, respectively. After adjustment for confounding variables, C/S rate and NMR were found correlated (r = -1.1, p < 0.001). Examination of the relationship between C/S rate and NMR in each WHO region resulted in an inverse correlation in Africa (r = -0.75, p = 0.005), Europe (r = -0.12, p < 0.001), South-East Asia (r = -0.41, p = 0.01), and Western Pacific (r = -0.13, p = 0.02), a direct correlation in America (r = 0.06, p = 0.04), and no correlation in Eastern Mediterranean (r = 0.01, p = 0.88). Meanwhile, C/S rate and NMR were inversely associated in regions with upper-middle (r = -0.15, p < 0.001) and lower-middle (r = -0.24, p < 0.001) income levels, directly associated in high-income regions (r = 0.02, p = 0.001), and not associated in low-income regions (p = 0.13). In countries with HDI below the centralized value of 1 (the real value of 0.9), the correlation between C/S rate and NMR was negative while it was found positive in countries with HDI higher than the mentioned cut-off.
This study indicated that NMR associated with C/S is dependent on various socioeconomic factors such as total fertility rate, HDI, GDP percentage, and maternal age at first childbearing. Further attentions to the socioeconomic status are warranted to minimize the NMR by modifying the C/S rate to the optimum cut-off.
在过去几十年中，全球范围内剖宫产率显著上升。在本基于人群的研究中，我们旨在评估剖宫产率与新生儿死亡率之间的关系。
本回顾性生态学研究纳入了 2000 年至 2015 年来自 166 个国家的纵向数据。我们评估了剖宫产率与新生儿死亡率（NMR）之间的关系，同时调整了总生育率、人类发展指数（HDI）、国内生产总值（GDP）百分比和初产妇年龄等混杂因素。我们还分别对不同地理区域和不同收入水平的区域进行了检查。
166 个纳入国家的剖宫产率和 NMR 分别为 19.97%±10.56%和 10±10.27/1000 活产儿。调整混杂因素后，发现剖宫产率与 NMR 相关（r=-1.1，p<0.001）。对世界卫生组织（WHO）各区域剖宫产率与 NMR 之间的关系进行检查，结果显示非洲（r=-0.75，p=0.005）、欧洲（r=-0.12，p<0.001）、东南亚（r=-0.41，p=0.01）和西太平洋（r=-0.13，p=0.02）呈负相关，美洲（r=0.06，p=0.04）呈正相关，而东地中海（r=0.01，p=0.88）无相关性。同时，在中高收入（r=-0.15，p<0.001）和中低收入（r=-0.24，p<0.001）地区，剖宫产率与 NMR 呈负相关，在高收入地区呈正相关（r=0.02，p=0.001），在低收入地区则无相关性（p=0.13）。在人类发展指数（HDI）低于 1 的集中值（实际值为 0.9）的国家，剖宫产率与 NMR 之间呈负相关，而在 HDI 高于上述截止值的国家则呈正相关。
本研究表明，与剖宫产相关的 NMR 与各种社会经济因素有关，如总生育率、HDI、GDP 百分比和初产妇年龄。需要进一步关注社会经济状况，通过将剖宫产率调整到最佳截止值，以降低 NMR。
