Comfort Lizelle, Jain Meaghan, Wu Haotian, Nathan Lisa
Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York.
Am J Perinatol. 2024 May;41(S 01):e1241-e1247. doi: 10.1055/a-2008-8540. Epub 2023 Jan 6.
Sociodemographic factors such as race/ethnicity and socioeconomic status affect primary cesarean delivery rates. Language is associated with disparate health care outcomes but has not been well studied in obstetrics. We examined the association between primary unscheduled cesarean delivery rate and preferred patient language.
A retrospective cohort study was conducted at an urban medical center between January 2017 and January 2020. Nulliparous women with early or full-term gestation and having no obstetric or medical contraindication to vaginal delivery were included. We used multivariable linear and logistic regressions to evaluate language differences in cesarean delivery odds and indication for cesarean.
Of the 1,314 eligible women, 76.8% of patients preferred English, 17.8% Spanish, and 5.4% other languages. Overall cesarean delivery rate was 27.6%. Controlling for age, race/ethnicity, body mass index, insurance, gravidity, pregnancy comorbidities, labor induction, and infant birth weight, Spanish- and other language-speaking women had significantly higher odds of undergoing cesarean compared with English-speaking women (adjusted odds ratio [OR]: 1.75; 95% confidence interval [CI]: 1.25, 2.46). Relative proportions of indications for cesarean did not differ by language group. Documented interpreter use was an effect modifier on the relationship between language preference and cesarean (OR with interpreter use: 2.89, 95% CI: 1.90, 4.39).
Primary cesarean delivery rates were significantly higher among nulliparous women who prefer languages other than English. This difference may reflect lack of communication, provider bias or discrimination, or other factors, and should be further studied. Interpreter services should be routinely utilized and documented effectively.
· Women who prefer languages other than English had higher odds of cesarean.. · Indication for cesarean did not differ by language.. · Interpreter use did not reduce risk for cesarean..
种族/民族和社会经济地位等社会人口学因素会影响首次剖宫产率。语言与不同的医疗保健结果相关，但在产科领域尚未得到充分研究。我们研究了首次非计划剖宫产率与患者首选语言之间的关联。
于2017年1月至2020年1月在一家城市医疗中心进行了一项回顾性队列研究。纳入了初产妇，她们处于早期或足月妊娠，且无阴道分娩的产科或医学禁忌证。我们使用多变量线性回归和逻辑回归来评估剖宫产几率和剖宫产指征方面的语言差异。
在1314名符合条件的女性中，76.8%的患者首选英语，17.8%首选西班牙语，5.4%首选其他语言。总体剖宫产率为27.6%。在控制了年龄、种族/民族、体重指数、保险、妊娠次数、妊娠合并症、引产和婴儿出生体重后，与说英语的女性相比，说西班牙语和其他语言的女性接受剖宫产的几率显著更高（调整后的优势比[OR]：1.75；95%置信区间[CI]：1.25，2.46）。剖宫产指征的相对比例在不同语言组之间没有差异。记录在案的口译员使用情况是语言偏好与剖宫产之间关系的一个效应修饰因素（使用口译员时的OR：2.89，95%CI：1.90，4.39）。
在首选非英语语言的初产妇中，首次剖宫产率显著更高。这种差异可能反映了沟通不畅、医疗服务提供者的偏见或歧视或其他因素，应进一步研究。应常规使用口译服务并有效记录。
· 首选非英语语言的女性剖宫产几率更高。· 剖宫产指征不因语言而异。· 使用口译员并未降低剖宫产风险。
