Spencer Sydney M, Laurent Amy A, Souter Vivienne L, Painter Ian S, Daly Colleen M
Microsoft Corporation, Redmond, WA, USA.
Department of Health Systems & Population Health, University of Washington, Seattle, WA, USA.
J Racial Ethn Health Disparities. 2025 Mar 26. doi: 10.1007/s40615-025-02401-0.
Cesarean outcomes are rarely investigated by Asian ethnicities when examining variation among low-risk, first-time birthing parents. We analyzed a clinical birth dataset of Northwestern U.S. hospitals to evaluate disparities in unplanned cesarean births among disaggregated Asian ethnicities.
This cross-sectional study used chart-abstracted birth data from 2017 through 2021. Analysis restrictions included hospitals reporting for the full timeframe, and patients who were nulliparous, term, singleton, vertex presentation, allowed to labor without a scheduled cesarean birth, and not intrapartum transfers or community births. Adjusted and unadjusted multi-level logistic regression compared the primary outcome of unplanned cesarean birth by race and Asian ethnicities.
A total of 40,160 births met inclusion criteria; 21.3% were Asian. Overall, the laboring cesarean rate was 23.1%, ranging from 33.9% for South Asians to 17.0% for East Asians. Compared to Whites, South Asians (OR 1.84, CI 1.66-2.04), Southeast Asians (OR 1.28, CI 1.05-1.55), and Asian unspecified (OR 1.27, CI 1.18-1.37) had significantly higher unadjusted odds of cesarean birth while East Asians had significantly lower odds (OR 0.73, CI 0.63-0.86). Odds for South Asian cesarean birth were more than doubled that of White births (aOR 2.18, CI 1.95-2.44) in the adjusted model.
After controlling for known risk factors, South Asians had elevated odds for unplanned cesarean birth compared to other races and ethnicities, despite lower risk factor incidence. Medical systems should collect disaggregated race and ethnicity data to provide pregnancy management insights for reducing inequities in low-risk unplanned cesarean births.
在研究低风险初产妇的差异时，亚洲种族很少对剖宫产结局进行调查。我们分析了美国西北部医院的临床分娩数据集，以评估不同亚洲种族间非计划剖宫产的差异。
这项横断面研究使用了2017年至2021年通过图表提取的分娩数据。分析限制包括在整个时间段内报告数据的医院，以及初产妇、足月、单胎、头位、允许自然分娩而非计划剖宫产、非产时转诊或社区分娩的患者。调整后的和未调整的多水平逻辑回归比较了按种族和亚洲种族划分的非计划剖宫产的主要结局。
共有40160例分娩符合纳入标准；21.3%为亚洲人。总体而言，分娩剖宫产率为23.1%，从南亚人的33.9%到东亚人的17.0%不等。与白人相比，南亚人（比值比1.84，95%置信区间1.66 - 2.04）、东南亚人（比值比1.28，95%置信区间1.05 - 1.55）和未明确种族的亚洲人（比值比1.27，95%置信区间1.18 - 1.37）剖宫产的未调整几率显著更高，而东亚人剖宫产的几率显著更低（比值比0.73，95%置信区间0.63 - 0.86）。在调整模型中，南亚人剖宫产的几率比白人分娩高出一倍多（调整后比值比2.18，95%置信区间1.95 - 2.44）。
在控制已知风险因素后，与其他种族相比，南亚人非计划剖宫产的几率升高，尽管其风险因素发生率较低。医疗系统应收集按种族和民族分类的数据，以提供妊娠管理方面的见解，减少低风险非计划剖宫产中的不平等现象。
