Bane Shalmali, Mujahid Mahasin S, Kan Peiyi, Main Elliot K, Carmichael Suzan L
Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA.
J Racial Ethn Health Disparities. 2025 May 6. doi: 10.1007/s40615-025-02464-z.
In the US, there is substantial variability in low-risk cesarean birth rate by hospitals and race/ethnicity. The contribution of inequitable hospital quality to disparities in low-risk cesarean births is uncertain. We examine the contribution of birth hospital to racial/ethnic disparities in low-risk cesarean births.
We used vital records linked with maternal birth hospitalization data (California, 2007-18). We examined self-reported race/ethnicity and low-risk cesarean birth, i.e., nulliparous, term, singleton, and vertex (NTSV) births. Poisson regression models with a mixed effect for hospital and bootstrapped errors were used to compare racial/ethnic differences in cesarean prevalence, adjusted for maternal and hospital characteristics. We used G-computation to assess how the prevalence of cesarean section by racial/ethnic group would change if all births occurred at the same distribution of hospitals as births to White individuals.
Among 1,594,277 NTSV births at 212 hospitals, 26.9% were cesarean. After adjustment for hospital characteristics, risk ratios for cesarean birth ranged from 1.05 for foreign-born Hispanic (95% CI 1.02-1.09) to 1.28 for Black (95% CI 1.22-1.33) individuals, relative to White individuals. In the G-computation substitution, cesarean prevalence among NTSV births was reduced for some race/ethnicities and increased for others, ranging from 87 excess events (0.3% increase) in Black populations to 6473 avoided events (5.6% decrease) among US-born Hispanic populations.
Racial/ethnic disparities in cesarean prevalence among low-risk births in California are not explained by individual-level maternal or hospital characteristics.
在美国，不同医院以及不同种族/族裔的低风险剖宫产率存在很大差异。医院质量不公平对低风险剖宫产差异的影响尚不确定。我们研究了分娩医院对低风险剖宫产中种族/族裔差异的影响。
我们使用了与产妇分娩住院数据相关的生命记录（加利福尼亚州，2007 - 2018年）。我们研究了自我报告的种族/族裔以及低风险剖宫产，即初产妇、足月、单胎和头位（NTSV）分娩。采用对医院具有混合效应和自抽样误差的泊松回归模型，比较剖宫产患病率的种族/族裔差异，并对产妇和医院特征进行了调整。我们使用G计算法来评估，如果所有分娩都在与白人分娩相同的医院分布情况下发生，不同种族/族裔群体的剖宫产患病率会如何变化。
在212家医院的1,594,277例NTSV分娩中，26.9%为剖宫产。在对医院特征进行调整后，相对于白人个体，剖宫产分娩的风险比范围从外国出生的西班牙裔的1.05（95%置信区间1.02 - 1.09）到黑人的1.28（95%置信区间1.22 - 1.33）。在G计算替代法中，一些种族/族裔的NTSV分娩中的剖宫产患病率有所降低，而另一些则有所增加，范围从黑人人群中的87例额外事件（增加0.3%）到美国出生的西班牙裔人群中的6473例避免事件（减少5.6%）。
加利福尼亚州低风险分娩中剖宫产患病率的种族/族裔差异不能用个体层面的产妇或医院特征来解释。
