McGregor Alecia J, Garman David, Hung Peiyin, Tosin-Oni Motunrayo, Orona Kaitlyn Camacho, Molina Rose L, Ciraldo Katrina J, Kozhimannil Katy Backes
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Department of Economics, Tufts University, Medford, Massachusetts, USA.
Health Serv Res. 2025 Apr;60(2):e14375. doi: 10.1111/1475-6773.14375. Epub 2024 Sep 7.
To examine racial inequities in low-risk and high-risk (or "medically appropriate") cesarean delivery rates in New Jersey during the era surrounding the United States cesarean surge and peak.
This retrospective repeated cross-sectional study examined the universe of childbirth hospitalizations in New Jersey from January 1, 2000 through September 30, 2015. We estimate the likelihood of cesarean delivery by maternal race and ethnicity, with mixed-level logistic regression models, stratified by cesarean risk level designated by the Society of Maternal Fetal Medicine (SMFM).
We used all-payer hospital discharge data from the Healthcare Cost and Utilization Project's State Inpatient Discharge Database and linked this data to the American Hospital Association Annual Survey. ZIP-code Tabulation Area (ZCTA)-level racialized economic segregation index data were from the 2007-2011 American Community Survey. We identified 1,604,976 statewide childbirth hospitalizations using International Classification of Diseases-9-CM (ICD-9) diagnosis and procedure codes and Diagnosis-Related Group codes, and created an indicator of cesarean delivery using ICD-9 codes.
Among low-risk deliveries, Black patients, particularly those in the age group of 35-39 years, had higher predicted probabilities of giving birth via cesarean than White people in the same age categories (Black-adjusted predicted probability = 24.0%; vs. White-adjusted predicted probability = 17.3%). Among high-risk deliveries, Black patients aged 35 to 39 years had a lower predicted probability (by 2.7 percentage points) of giving birth via cesarean compared with their White counterparts.
This study uncovered a lack of medically appropriate cesarean delivery for Black patients, with low-risk Black patients at higher odds of cesarean delivery and high-risk Black patients at lower odds of cesarean than their White counterparts. The significant Black-White inequities highlight the need to address misalignment of evidence-based cesarean delivery practice in the efforts to improve maternal health equity. Quality metrics that track whether cesareans are provided when medically needed may contribute to clinical and policy efforts to prevent disproportionate maternal morbidity and mortality among Black patients.
研究在美国剖宫产率激增和达到峰值的时期，新泽西州低风险和高风险（或“医学上适宜的”）剖宫产率中的种族不平等现象。
这项回顾性重复横断面研究调查了2000年1月1日至2015年9月30日新泽西州所有分娩住院病例。我们使用混合水平逻辑回归模型，按母胎医学协会（SMFM）指定的剖宫产风险水平分层，估计按产妇种族和民族划分的剖宫产可能性。
我们使用了医疗成本与利用项目的州住院患者出院数据库中的全支付者医院出院数据，并将此数据与美国医院协会年度调查相链接。邮政编码分区（ZCTA）层面的种族化经济隔离指数数据来自2007 - 2011年美国社区调查。我们使用国际疾病分类第九版临床修订本（ICD - 9）诊断和程序代码以及诊断相关分组代码，确定了全州1,604,976例分娩住院病例，并使用ICD - 9代码创建了剖宫产指标。
在低风险分娩中，黑人患者，尤其是年龄在35 - 39岁的患者，剖宫产的预测概率高于同年龄组的白人（黑人调整后的预测概率 = 24.0%；白人调整后的预测概率 = 17.3%）。在高风险分娩中，35至39岁的黑人患者剖宫产的预测概率比白人患者低（低2.7个百分点）。
本研究发现黑人患者缺乏医学上适宜的剖宫产，低风险黑人患者剖宫产几率高于白人，而高风险黑人患者剖宫产几率低于白人。显著的黑白不平等凸显了在努力改善孕产妇健康公平性方面解决循证剖宫产实践偏差的必要性。跟踪在医学需要时是否进行剖宫产的质量指标可能有助于临床和政策努力，以预防黑人患者中不成比例的孕产妇发病率和死亡率。
