Racial and Ethnic Disparities in Primary Cesarean Birth and Adverse Outcomes Among Low-Risk Nulliparous People.
Racial and Ethnic Disparities in Primary Cesarean Birth and Adverse Outcomes Among Low-Risk Nulliparous People.
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DOI：
10.1097/aog.0000000000004953
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发表时间：
2022-11-01
影响因子：
7.2
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中科院分区：
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目的：比较不同种族和民族（非西班牙裔白色、非西班牙裔黑人和西班牙裔）中低风险妊娠的初次剖宫产率和复合新生儿和母体不良结局的趋势：这项基于人群的队列研究使用美国生命统计数据（2015-2019年）评估低风险、未经产的非异常单胎患者，这些患者在妊娠37-41周分娩。主要结局是初次剖宫产率。次要结局包括复合新生儿不良结局（5分钟时Apgar评分小于5分，辅助通气超过6小时，癫痫发作或死亡），复合母体不良结局（入住重症监护室，输血，子宫破裂或计划外子宫切除术）以及婴儿死亡。多变量泊松回归模型被用来估计调整后的相对危险度（aRR）和95%CIs.RESULTS：在430万出生，60.6%确定为非西班牙裔白色，14.6%确定为非西班牙裔黑人，24.8%确定为西班牙裔。初次剖宫产率为18.5%（n= 804，155）。多变量校正后，与非西班牙裔白色个体（18.1%）相比，非西班牙裔黑人（21.7%，aRR 1.24，95% CI 1.23-1.25）和西班牙裔（17.3%，aRR 1.09，95% CI 1.09-1.10）个体的剖宫产风险增加。在所有种族和民族组中，初次剖宫产率呈上升趋势（所有组的线性趋势P < 0.001）。然而，在研究期间，初次剖宫产率的种族和民族差异保持稳定。在所有新生儿中，西班牙裔个体的复合新生儿不良结局较低（10.7 vs 8.3/1，000活产，aRR 0.74，95%CI 0.72-0.75）和初次剖宫产分娩的新生儿（18.5对15.0每1,000活产，aRR 0.73，95%CI 0.70-0.76），与非西班牙裔白色individual.CONCLUSION：使用在美国的全国代表性样本，我们发现在低风险未经产患者的主要剖宫产率的种族和民族差异，这在整个研究期间持续存在。
OBJECTIVE:To compare trend of primary cesarean delivery rate and composite neonatal and maternal adverse outcomes in low-risk pregnancies among racial and ethnic groups: non-Hispanic White, non-Hispanic Black, and Hispanic.METHODS:This population-based cohort study used US vital statistics data (2015–2019) to evaluate low-risk, nulliparous patients with nonanomalous singletons who labored and delivered at 37–41 weeks of gestation. The primary outcome was the primary cesarean delivery rate. Secondary outcomes included composite neonatal adverse outcome (Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, seizure, or death), and composite maternal adverse outcome (intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy), as well as infant death. Multivariable Poisson regression models were used to estimate adjusted relative risks (aRR) and 95% CIs.RESULTS:Among 4.3 million births, 60.6% identified as non-Hispanic White, 14.6% identified as non-Hispanic Black, and 24.8% identified as Hispanic. The rate of primary cesarean delivery was 18.5%(n= 804,155). An increased risk for cesarean delivery was found in non-Hispanic Black (21.7%, aRR 1.24, 95% CI 1.23–1.25) and Hispanic (17.3%, aRR 1.09, 95% CI 1.09–1.10) individuals, compared with non-Hispanic White individuals (18.1%) after multivariable adjustment. There was an upward trend in the rate of primary cesarean delivery in all racial and ethnic groups (P for linear trend< 0.001 for all groups). However, the racial and ethnic disparity in the rate of primary cesarean delivery remained stable during the study period. The composite neonatal adverse outcome was lower in Hispanic individuals in all newborns (10.7 vs 8.3 per 1,000 live births, aRR 0.74, 95% CI 0.72–0.75), and in newborns delivered by primary cesarean delivery (18.5 vs 15.0 per 1,000 live births, aRR 0.73, 95% CI 0.70–0.76), compared with non-Hispanic White individuals.CONCLUSION:Using a nationally representative sample in the United States, we found racial and ethnic disparities in the primary cesarean delivery rate in low-risk nulliparous patients, which persisted throughout the study period.