Quality and equality in obstetric care: racial and ethnic differences in caesarean section delivery rates
Quality and equality in obstetric care: racial and ethnic differences in caesarean section delivery rates
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DOI：
10.1111/j.1365-3016.2009.01059.x
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发表时间：
2009-09-01
影响因子：
2.8
通讯作者：
Caughey, Aaron B.
中科院分区：
文献类型：
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作者：
Bryant, Allison S.;Washington, Sierra;Caughey, Aaron B.
我们试图研究剖宫产（CS）分娩的种族/民族差异，特别是在低风险的妇女中。为此，我们在加州大学旧金山分校（三级医疗学术中心）进行了一项回顾性队列研究。1980年至2001年间出生的婴儿被纳入分析。排除了多胎妊娠、胎儿非头位或其他已知阴道分娩禁忌症的妇女。共有28493名非裔美国人、亚洲人、拉丁裔和白人妇女接受了研究。创建风险调整模型以探索不同种族/民族的CS风险差异。我们还对CS风险相对较低的女性亚组进行了分析，并探讨了观察到的差异随时间的变化。总CS率为15.8%。拉丁裔的绝对比率最高（16.7%），亚裔最低（14.7%）。在对已知的危险因素进行调整后，非洲裔美国妇女患CS的几率是白人妇女的1.48倍[95%可信区间（CI） 1.31, 1.68]，拉丁裔妇女患CS的几率是白人妇女的1.19倍[95% CI 1.05, 1.34]。对混杂因素的逐步调整表明，这种变异不能完全由已知的危险因素来解释。这些差异甚至存在于CS风险较低的女性中，并且随着时间的推移而持续存在。我们的结论是，即使在被认为风险较低的妇女中，CS分娩的种族和民族差异也存在；利率并没有随着时间的推移而改善。无论是在国家、州、医院还是提供者层面，应将风险调整后的CS差异视为产科护理的质量指标。
We sought to examine racial/ethnic differences in deliveries by caesarean section (CS) over time, particularly among women at low risk for this procedure. To do so, we conducted a retrospective cohort study at the University of California, San Francisco, a tertiary care academic centre. Births occurring between 1980 and 2001 were included in the analyses. Women with multiple gestations, fetuses in other than the cephalic presentation or with other known contraindications to vaginal birth were excluded. A total of 28 493 African American, Asian, Latina and White women were studied. Risk-adjusted models were created to explore differences in CS risk by race/ethnicity. We also performed analyses of subgroups of women at relatively low risk of CS, and explored changes in observed disparities over time.The overall CS rate was 15.8%. The absolute rate was highest among Latinas (16.7%) and lowest among Asians (14.7%). After adjustment for known risk factors, African American women had a 1.48 times greater odds of having a CS than did White women [95% confidence interval (CI) 1.31, 1.68], and Latina women had a 1.19 times greater odds [95% CI 1.05, 1.34]. Stepwise adjustment for confounders showed that this variation is not entirely explained by known risk factors. These differences exist even for women at low risk of CS, and have persisted over time. We conclude that racial and ethnic disparities in CS delivery exist, even among women presumed to be at lower risk of CS; rates have not improved with time. Disparities in risk-adjusted CS should be considered as a quality metric for obstetric care, whether at the national, state, hospital or provider level.