Tsui Wing Lam, Deng Guang-Hong, Hsieh Tsung-Cheng, Ding Dah-Ching
Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan.
Tzu Chi University Research Center for Big Data Teaching, Research and Statistic Consultation, Tzu Chi University, Hualien, Taiwan.
Medicine (Baltimore). 2024 Dec 6;103(49):e40811. doi: 10.1097/MD.0000000000040811.
Many factors can affect delivery mode decisions. Therefore, this study aimed to explore the effects of maternal age, physician's sex, region, income, and hospital type on cesarean section (C/S) delivery rates between 2008 and 2018 in Taiwan. In this population-based cross-sectional study, data were extracted from the Taiwan National Health Insurance Research Database (2 million individuals). The logistic regression method was used to analyze the aforementioned risk factors, and data are expressed as odds ratios (ORs) and 95% confidence intervals. In total, 9826 and 9714 deliveries in 2008 and 2018, respectively, were included in the analysis. The C/S ratio increased from 16.5% (n = 1607) in 2008 to 19.7% (n = 1916) in 2018. A higher C/S risk for women aged >34 years (ORs: 2.835 and 2.225 in 2008 and 2018, respectively) than for those aged ≤34 years was noted in both years. Female physicians had a lower risk of performing C/S than male physicians in 2008 (OR: .762, 95% confidence interval: .625-.928), but this was not apparent in 2018. Higher income levels (>new Taiwan dollar 45,081) and central Taiwan were associated with a lower C/S risk in both years. Private, not-for-profit hospitals had a lower C/S risk in 2008, which was not apparent in 2018. In conclusion, this study revealed a significant increase in C/S rates over the past decade, which was influenced by multiple factors. Maternal age, physician's sex, income status, location, and type of hospital may influence C/S rates. Analyzing these relationships can inform the development of strategies aimed at reducing future C/S rates, and targeted interventions may reduce the C/S rates.
许多因素会影响分娩方式的决策。因此，本研究旨在探讨2008年至2018年期间台湾地区产妇年龄、医生性别、地区、收入和医院类型对剖宫产（C/S）分娩率的影响。在这项基于人群的横断面研究中，数据取自台湾全民健康保险研究数据库（200万个体）。采用逻辑回归方法分析上述风险因素，数据以比值比（OR）和95%置信区间表示。分析共纳入2008年的9826例分娩和2018年的9714例分娩。剖宫产率从2008年的16.5%（n = 1607）升至2018年的19.7%（n = 1916）。在这两年中，均发现年龄>34岁的女性进行剖宫产的风险高于年龄≤34岁的女性（2008年和2018年的OR分别为2.835和2.225）。2008年，女医生进行剖宫产的风险低于男医生（OR：0.762，95%置信区间：0.625 - 0.928），但在2018年这种差异不明显。在这两年中，较高的收入水平（>新台币45,081元）和台湾中部地区与较低的剖宫产风险相关。2008年，私立非营利性医院的剖宫产风险较低，2018年这种差异不明显。总之，本研究显示过去十年剖宫产率显著上升，这受到多种因素影响。产妇年龄、医生性别、收入状况、地点和医院类型可能会影响剖宫产率。分析这些关系可为制定旨在降低未来剖宫产率的策略提供依据，针对性干预可能会降低剖宫产率。
