Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study.
Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study.
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DOI：
10.1136/bmj.c5065
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发表时间：
2010-10-06
期刊：
影响因子：
--
通讯作者：
van der Meulen JH
中科院分区：
文献类型：
--
作者：
Bragg F;Cromwell DA;Edozien LC;Gurol-Urganci I;Mahmood TA;Templeton A;van der Meulen JH
目的确定英国NHS信托机构常规数据中未校正的剖腹产率变化是否可以用母亲特征和临床危险因素来解释。设计采用常规收集的医院事件统计数据进行横断面分析。采用多元逻辑回归模型，根据产妇特征（年龄、种族、产次和社会经济贫困）和临床风险因素（既往剖腹产、臀位和胎儿窘迫），估计妇女进行剖腹产的可能性。调整后的剖腹产率为每个国民保健服务的信任，从这个模型。设置146个英国NHS信托。2008年1月1日至12月31日期间，年龄在15至44岁之间，生育一个孩子的妇女。主要结果测量每100例分娩（活产或死产）的剖腹产率。结果620604例单胎中，剖宫产147726例（23.8%）。妇女更有可能有剖腹产，如果他们有一个以前（70.8%）或有一个婴儿臀位（89.8%）。NHS信托基金中未经调整的剖腹产率为13.6%至31.9%。信托在其患者人群中有所不同，但调整后的比率仍在14.9%至32.1%之间。紧急剖腹产率在信托之间的差异大于选择性剖腹产率。结论在NHS信托机构分娩的妇女的特征不同，应避免比较未经调整的剖腹产率。调整后的剖腹产率仍然有很大的差异，试图减少这种变化应检查与紧急剖腹产有关的问题。
Objective To determine whether the variation in unadjusted rates of caesarean section derived from routine data in NHS trusts in England can be explained by maternal characteristics and clinical risk factors. Design A cross sectional analysis using routinely collected hospital episode statistics was performed. A multiple logistic regression model was used to estimate the likelihood of women having a caesarean section given their maternal characteristics (age, ethnicity, parity, and socioeconomic deprivation) and clinical risk factors (previous caesarean section, breech presentation, and fetal distress). Adjusted rates of caesarean section for each NHS trust were produced from this model. Setting 146 English NHS trusts. Population Women aged between 15 and 44 years with a singleton birth between 1 January and 31 December 2008. Main outcome measure Rate of caesarean sections per 100 births (live or stillborn). Results Among 620 604 singleton births, 147 726 (23.8%) were delivered by caesarean section. Women were more likely to have a caesarean section if they had had one previously (70.8%) or had a baby with breech presentation (89.8%). Unadjusted rates of caesarean section among the NHS trusts ranged from 13.6% to 31.9%. Trusts differed in their patient populations, but adjusted rates still ranged from 14.9% to 32.1%. Rates of emergency caesarean section varied between trusts more than rates of elective caesarean section. Conclusion Characteristics of women delivering at NHS trusts differ, and comparing unadjusted rates of caesarean section should be avoided. Adjusted rates of caesarean section still vary considerably and attempts to reduce this variation should examine issues linked to emergency caesarean section.
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DOI：
10.1111/j.1471-0528.2005.00501.x
发表时间：
2005-05-01
影响因子：
5.8
作者：
Paranjothy, S;Frost, C;Thomas, J
通讯作者：
Thomas, J
影响因子：
7.2
作者：
Deneux-Tharaux, Catherine;Carmona, Elodie;Breart, Gerard
通讯作者：
Breart, Gerard
影响因子：
120.7
作者：
Aron, DC;Harper, DL;Rosenthal, GE
通讯作者：
Rosenthal, GE
影响因子：
8.4
作者：
Brown, Heather C.;Paranjothy, Shantini;Dowswell, Therese;Thomas, Jane
通讯作者：
Thomas, Jane
影响因子：
158.5
作者：
Lydon-Rochelle, M;Holt, VL;Martin, DP
通讯作者：
Martin, DP