Demographic, Socioeconomic, Health Systems, and Geographic Factors Associated with Vaginal Birth After Cesarean: An Analysis of 2017 U.S. Birth Certificate Data.
Demographic, Socioeconomic, Health Systems, and Geographic Factors Associated with Vaginal Birth After Cesarean: An Analysis of 2017 U.S. Birth Certificate Data.
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DOI：
10.1007/s10995-020-03066-3
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发表时间：
2021-07
影响因子：
2.3
通讯作者：
Holland ML
中科院分区：
文献类型：
--
作者：
Basile Ibrahim B;Kennedy HP;Holland ML
为了更好地了解美国目前剖腹产后阴道分娩(VBAC)的比率，我们使用了2017年美国国家出生证明数据来检查与VBAC女性相关的社会人口和地理因素。使用2017年出生限制地理数据集和区块序贯Logistic回归分析了与2017年美国有1到2次剖腹产史(N=540,711)的妇女后续生育相关的社会人口学和地理因素。与白人女性相比，黑人女性患VBAC的调整优势比白人女性高6%(95%CI：1.04，1.08)，美国印第安人/阿拉斯加原住民女性VBAC的调整优势比白人女性高18%(AOR 1.18；95%CI：1.10，1.27)。与有剖腹产历史的类似白人妇女相比，亚洲/太平洋岛民妇女患VBAC的可能性低9%(AOR 0.91；95%CI：0.88，0.94)。与非拉丁裔女性相比，拉美裔女性患VBAC的可能性低10%(AOR 0.90；95%CI：0.88，0.92)。受过高中教育(AOR 0.85；95%CI：0.83，0.88)或大学学历(AOR 0.85；95%CI：0.84，0.87)的女性患VBAC的可能性低于受过学士或更高学历教育的女性。由医疗补助支付分娩费用的妇女患VBAC的可能性比有私人保险的妇女高5%(AOR 1.05，95%CI：1.03，1.07)。与使用私人保险的妇女相比，自付费用的妇女患VBAC的可能性是前者的两倍(AOR 1.99；95%CI 1.92，2.07)。与美国东北部的妇女相比，南部各州分娩的妇女患VBAC的调整后几率最低(AOR 0.72；95%CI：0.71，0.74)，而中西部地区的VBAC妇女患VBAC的几率最高(AOR 1.19；95%CI：1.16，1.22)。有VBAC的妇女中有13%(13%)有注册助产士(CNM)助产士，这比全国CNM接生率高44%。根据许多社会人口和地理因素，VBAC的发生率存在显著差异，这可能反映了剖宫产后获得阴道分娩机会的差异以及对剖腹产后分娩方式的偏好差异。建议进行进一步的研究，以更好地了解和解决这些差异，以改善产妇保健。
In order to better understand the current rates of vaginal birth after cesarean (VBAC) in the United States, the 2017 U.S. national birth certificate data were used to examine sociodemographic and geographic factors associated with women who had a VBAC. The 2017 Natality Limited Geography Dataset and block sequential logistic regression were used to examine sociodemographic and geographic factors associated with subsequent births in 2017 in the United States to women with a history of 1 or 2 cesareans (N=540,711). The adjusted odds of VBAC were 6% higher for black women (1.06; 95% CI: 1.04, 1.08) and 18% higher for American Indian/Alaskan Native women (aOR 1.18; 95% CI: 1.10, 1.27) relative to white women. Asian/Pacific Islander women were 9% less likely to have a VBAC (aOR 0.91; 95% CI: 0.88, 0.94) than similar white women with a history of cesarean delivery. Latina women had a 10% less likelihood to have a VBAC (aOR 0.90; 95% CI: 0.88, 0.92) when compared with non-Latina women. Women with a high school education (aOR 0.85; 95% CI: 0.83,0.88) or some college (aOR 0.85; 95% CI: 0.84,0.87) were less likely to have a VBAC than women educated at a baccalaureate level or higher. Women whose births were paid for by Medicaid had a 5% increased likelihood of VBAC over women with private insurance (aOR 1.05, 95% CI: 1.03, 1.07). Women who self-pay have twice the likelihood of VBAC (aOR 1.99; 95% CI 1.92, 2.07) compared to women with private insurance. The adjusted odds of VBAC were lowest for women giving birth in Southern states (aOR 0.72; 95% CI: 0.71, 0.74) and highest for women giving birth in the Midwest (aOR 1.19; 95% CI: 1.16, 1.22) relative to women in the Northeastern U.S. Thirteen percent (13%) of women who had a VBAC had a certified nurse-midwife (CNM) birth attendant, which is 44% higher than the national CNM-attended birth rate. Significant variation exists in VBAC rates based on a number of sociodemographic and geographic factors, likely reflecting disparities in access to vaginal birth after cesarean and differences in preference regarding mode of birth after cesarean. Further research is recommended to better understand and address these disparities to improve maternity care.
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影响因子：
3.1
作者：
Barger MK;Dunn JT;Bearman S;DeLain M;Gates E
通讯作者：
Gates E
影响因子：
2.5
作者：
Cox, Kim J.;Bovbjerg, Marit L.;Leeman, Lawrence M.
通讯作者：
Leeman, Lawrence M.
影响因子：
7.2
作者：
通讯作者：
--
影响因子：
3.3
作者：
Dietz, Patricia;Bombard, Jennifer;Farr, Sherry
通讯作者：
Farr, Sherry
影响因子：
2.3
作者：
Edmonds, Joyce K.;Hawkins, Summer Sherburne;Cohen, Bruce B.
通讯作者：
Cohen, Bruce B.