Factors Associated With Variation in Cesarean Rates

与剖宫产率变化相关的因素

• 批准号: 6935859
• 负责人: KORAY TANFER
• 金额: $ 64.76万
• 依托单位: BATTELLE CENTERS/PUB HLTH RES & EVALUATN
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-08-15 至 2007-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6935859
• 关键词: birth; cesarean section; clinical research; epidemiology; female; health care cost /financing; health care service evaluation; health care service utilization; health services research tag; health surveys; human pregnant subject; human subject; interview; obstetrics; preadmission counseling

DESCRIPTION (provided by applicant): Cesarean section is major surgery, and as in most surgical procedures, there are health risks to both the mother and the baby. Despite the recommendation of the U.S. Department of Health and Human Services (DHHS) in Healthy People 2000, and in Healthy People 2010 to reduce the number of deliveries by cesarean section, the number of cesarean deliveries in the U.S. have increased from 6% of all deliveries in 1970 to nearly 25% in 2001 ranging from 29.9 in Louisiana to 17.2 in Utah (Martin et al. 2002). Cesarean rates were higher among black women than among white, and Hispanic women, and cesarean delivery rates increased with age, doubling from age 20-24 to age 35-39. The proposed research has three specific aims: (1) to analyze biennial data from the National Hospital Discharge Surveys (NHDS) from 1990 to 2002 to examine the individual-level variation in the likelihood of a cesarean delivery, by patient characteristics, hospital ownership, size, location, and payment source; (2) to analyze biennial Natality Data from the National Vital Statistics from 1990 and 2002 to examine the variation in cesarean rates across different levels of aggregation (i.e., county, city, state, and region), and over time by patient mix and community-level characteristics; and (3) to conduct a pre- and post-delivery survey with a sample of women who are in the third trimester (around the 26 the week) of their pregnancy at the first interview, and with their prenatal health care provider (e.g., physician, obstetrician, or midwife) to collect patient-, provider-, and hospital-level information that will allow us to conduct an in-depth examination of the non-clinical (non-obstetric) factors that might lead to a cesarean delivery. We will attach hospital-level and community-level information to each patient's survey data. This phase of the research will be a guided by a health care utilization model (Andersen 1968). The three specific aims comprise complementary analyses that examine different aspects of the same research problem and address different research questions. To attain our analytical objectives we will use descriptive and multivariate analysis techniques, such as, bivariate linear regression, multiple regression, logistic regression, multinomial Iogit regression, and hierarchical linear modeling (or random-effects model) as appropriate. The results from the proposed study will help explain the temporal and geographical variation in cesarean delivery rates, and contribute to our understanding of the multi-level factors associated with elective (i.e., in the absence of clinical indications) cesarean section.

描述（由申请人提供）：剖腹产是一项大手术，与大多数外科手术一样，对母亲和婴儿都存在健康风险。尽管美国卫生与公众服务部 (DHHS) 在《健康人民 2000》和《健康人民 2010》中建议减少剖腹产分娩数量，但美国剖腹产分娩数量已从 1970 年占所有分娩的 6% 增加到 2001 年的近 25%，从路易斯安那州的 29.9 例增加到犹他州的 17.2 例（马丁等人，2002）。黑人女性的剖腹产率高于白人和西班牙裔女性，剖腹产率随着年龄的增长而增加，从 20-24 岁到 35-39 岁，剖腹产率翻倍。拟议的研究有三个具体目标：(1) 分析 1990 年至 2002 年全国医院出院调查 (NHDS) 的两年期数据，根据患者特征、医院所有权、规模、位置和支付来源，检查剖腹产可能性的个体差异； (2) 分析 1990 年和 2002 年国家生命统计中的两年期出生率数据，以检查不同聚合级别（即县、市、州和地区）的剖宫产率的变化，以及随着时间的推移，按患者组合和社区层面的特征划分的剖宫产率的变化； (3) 对第一次访谈时处于妊娠晚期（大约第 26 周）的妇女样本及其产前保健提供者（例如医生、产科医生或助产士）进行产前和产后调查，以收集患者、提供者和医院层面的信息，使我们能够深入检查影响妊娠的非临床（非产科）因素。 可能会导致剖腹产。我们会将医院层面和社区层面的信息附加到每个患者的调查数据中。这一阶段的研究将以医疗保健利用模型为指导（Andersen 1968）。这三个具体目标包括互补分析，检查同一研究问题的不同方面并解决不同的研究问题。为了实现我们的分析目标，我们将酌情使用描述性和多变量分析技术，例如二元线性回归、多元回归、逻辑回归、多项式 Iogit 回归和分层线性模型（或随机效应模型）。拟议研究的结果将有助于解释剖宫产率的时间和地理变化，并有助于我们理解与选择性剖宫产（即在没有临床指征的情况下）相关的多层次因素。