在 COVID-19 大流行期间实施居家令前后，美国 2017-2021 年间，不同种族和民族群体及各州初产妇、足月、单胎、头位分娩的剖宫产率差异。
Differences in Cesarean Rates for Nulliparous, Term, Singleton, Vertex Births Among Racial and Ethnic Groups and States Before and After Stay-at-Home Orders During the COVID-19 Pandemic, United States, 2017-2021.
机构信息
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Division of Public Health, Delaware Department of Health and Social Services, Dover, DE, USA.
出版信息
Public Health Rep. 2024 Sep-Oct;139(5):615-625. doi: 10.1177/00333549241236629. Epub 2024 Mar 19.
OBJECTIVES
Evidence is limited on differences in cesarean rates for nulliparous, term, singleton, vertex (NTSV) births across racial and ethnic groups at the national and state level during the COVID-19 pandemic. We assessed changes in levels and trends of NTSV cesarean rates before and after stay-at-home orders (SAHOs) were implemented in the United States (1) overall, (2) by racial and ethnic groups, and (3) by 50 US states from January 2017 through December 2021.
METHODS
We used birth certificate data from 2017 through 2021, restricted to hospital births, to calculate monthly NTSV cesarean rates for the United States and for racial and ethnic groups and to calculate quarterly NTSV cesarean rates for the 50 states. We used interrupted time-series analysis to measure changes in NTSV cesarean rates before and after implementation of SAHOs (March 1 through May 31, 2020).
RESULTS
Of 6 022 552 NTSV hospital births, 1 579 645 (26.2%) were cesarean births. Before implementation of SAHOs, NTSV cesarean rates were declining in the United States overall; were declining among births to non-Hispanic Asian, non-Hispanic Black, Hispanic, and non-Hispanic White women; and were declining in 6 states. During the first month of implementation of SAHOs in May 2020, monthly NTSV rates increased in the United States by 0.55%. Monthly NTSV rates increased by 1.20% among non-Hispanic Black women, 0.90% among Hispanic women, and 0.28% among non-Hispanic White women; quarterly NTSV rates increased in 6 states.
CONCLUSION
In addition to emergency preparedness planning, hospital monitoring, and reporting of NTSV cesarean rates to increase provider awareness, reallocation and prioritization of resources may help to identify potential strains on health care systems during public health emergencies such as the COVID-19 pandemic.
目的
在 COVID-19 大流行期间，我们评估了美国全国和各州层面初产妇、足月、单胎、头位（NTSV）分娩的剖宫产率在种族和民族群体之间的差异，评估了在实施就地避难令（SAHO）前后 NTSV 剖宫产率的水平和趋势（1）总体情况，（2）按种族和民族群体，（3）按 2017 年 1 月至 2021 年 12 月的 50 个美国州。
方法
我们使用 2017 年至 2021 年的出生证明数据，仅限于医院分娩，计算了美国和种族和民族群体的每月 NTSV 剖宫产率，并计算了 50 个州的每季度 NTSV 剖宫产率。我们使用中断时间序列分析来衡量 SAHO 实施前后（2020 年 3 月 1 日至 5 月 31 日）NTSV 剖宫产率的变化。
结果
在 6022552 例 NTSV 医院分娩中，1579645 例（26.2%）为剖宫产分娩。在实施 SAHO 之前，美国整体的 NTSV 剖宫产率呈下降趋势；非西班牙裔亚洲人、非西班牙裔黑人、西班牙裔和非西班牙裔白人产妇的分娩率呈下降趋势；6 个州的分娩率也呈下降趋势。在 2020 年 5 月 SAHO 实施的第一个月，美国每月 NTSV 率上升了 0.55%。非西班牙裔黑人女性的每月 NTSV 率上升了 1.20%，西班牙裔女性上升了 0.90%，非西班牙裔白人女性上升了 0.28%；6 个州的季度 NTSV 率上升。
结论
除了应急准备规划、医院监测和报告 NTSV 剖宫产率以提高提供者意识外，资源的重新分配和优先排序可能有助于在 COVID-19 大流行等公共卫生紧急情况下识别对医疗保健系统的潜在压力。
Zotero 插件