SOCIOECONOMIC-FACTORS AND THE ODDS OF VAGINAL BIRTH AFTER CESAREAN DELIVERY
SOCIOECONOMIC-FACTORS AND THE ODDS OF VAGINAL BIRTH AFTER CESAREAN DELIVERY
复制标题
DOI：
10.1001/jama.272.7.524
复制
发表时间：
1994-08-17
影响因子：
120.7
通讯作者：
LAHIRI, K
中科院分区：
文献类型：
--
作者：
KING, DE;LAHIRI, K
目的：在控制重要的临床因素的同时，确定社会经济、组织和职业责任因素对剖宫产后阴道分娩(VBAC)几率的独立影响。设计：1989年纽约州生命统计数据的回顾研究，补充关于县和医院特定变量的附加信息。使用多元Logistic回归分析，得出了15个自变量的优势比(OR)和95%的可信区间(CLS)。设定-在纽约州的104家医院出生。数据集。-有剖腹产史的纽约州居民共出生13944例，其中3068例(22%)为阴道分娩。受教育12年的OR值为1.15(95%Cl0.99~1.34)，13~15年的OR值为1.36(95%Cl1.16~1.60)，16年的OR值为1.59(95%Cl1.32~1.93)，17年及以上的OR值为2.00(95%Cl1.64~2.45)。新生儿重症监护和中度监护的OR值分别为1.55(95%CI，1.34~1.81)和1.30(95%CI，1.18~1.44)。参加保健组织的OR值为1.15(95%CI，1.02~1.30)，在公立医院分娩的OR值为0.77(95%CI，0.63~0.94)。非裔和西班牙裔母亲VBAC的OR值分别为0.80(95%CI，0.70~0.93)和0.61(95%CI，0.51~0.73)。医生年医疗事故保险费增加5000美元和医院因医疗事故索赔造成的赔偿损失的OR值分别为0.98(95%CI，0.97~0.99)和1.01(95%CI，0.99~1.03)。结论：除临床因素外，母亲的教育程度、种族和所在医院的具体特征也影响剖宫产后阴道分娩的几率。根据我们的分析，我们不能得出结论，专业责任因素影响VBAC费率。
Objective.-To determine the independent effect of socioeconomic, organizational, and professional liability factors on the odds of vaginal birth after cesarean delivery (VBAC) while controlling for important clinical factors.Design.-A retrospective study of 1989 New York State vital statistics data, supplemented with additional information on county- and hospital-specific variables. Using multiple logistic regression analysis, odds ratios (ORs) and 95% confidence intervals (Cls) were derived for 15 independent variables.Setting.-Births occurring in 104 New York State hospitals.Data Set.-A total of 13944 births occurring to New York State residents with a history of cesarean delivery of which 3068 (22%) were vaginal deliveries.Results.-The odds of VBAC increased with maternal education. The ORs were 1.15 (95% Cl, 0.99 to 1.34) for 12 years of education; 1.36 (95% Cl, 1.16 to 1.60) for 13 to 15 years; 1.59 (95% Cl, 1.32 to 1.93) for 16 years, and 2.00 (95% Cl, 1.64 to 2.45) for 17 years or more. The ORs also increased with the level of care provided by the hospital; they were 1.55 (95% Cl, 1.34 to 1.81) and 1.30 (95% Cl, 1.18 to 1.44) for hospitals with intensive and intermediate neonatal care facilities, respectively. The ORs were 1.15 (95% Cl, 1.02 to 1.30) for health maintenance organization participants and 0.77 (95% Cl, 0.63 to 0.94) for women giving birth in government hospitals. The ORs of VBAC for African-American and Hispanic mothers were 0.80 (95% Cl, 0.70 to 0.93) and 0.61 (95% Cl, 0.51 to 0.73), respectively. The ORs for a $5000 increase in physician's yearly malpractice premium and the hospital's paid loss due to malpractice claim settlements were 0.98 (95% Cl, 0.97 to 0.99) and 1.01 (95% Cl, 0.99 to 1.03), respectively.Conclusions.-ln addition to clinical factors, a mother's level of education and ethnicity and specific characteristics of the hospital in which she delivers affect the odds of a vaginal delivery after a previous cesarean delivery. From our analysis, we cannot conclude that professional liability factors affected VBAC rates.