Variation in Vaginal Birth After Cesarean by Maternal Race and Detailed Ethnicity
Variation in Vaginal Birth After Cesarean by Maternal Race and Detailed Ethnicity
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DOI：
10.1007/s10995-015-1897-5
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发表时间：
2016-06-01
影响因子：
2.3
通讯作者：
Cohen, Bruce B.
中科院分区：
文献类型：
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作者：
Edmonds, Joyce K.;Hawkins, Summer Sherburne;Cohen, Bruce B.
目的探讨马萨诸塞州妇女剖宫产后阴道分娩的可能性。方法我们使用足月、单胎、头位重复剖宫产或VBAC的出生证明数据，进行逻辑回归模型，以检查按种族和民族标准分类以及31个详细种族分类的女性发生VBAC的可能性。分析了整个研究期间（1996-2010，N = 119，752）和过去5年（2006-2010，N = 46，081）的数据。结果与非西班牙裔白色女性相比，非西班牙裔黑人母亲的VBAC校正比值最低（0.91，CI [0.85，0.98]），亚洲/太平洋岛民母亲的VBAC校正比值最高（1.41，CI [1.31，1.53]）。VBAC比率从巴西人的5.8%到巴西人的29.3%不等。相对于自我认定的美国母亲，30个种族中有7个种族的VBAC调整后的比值较低（AOR范围为0.40-0.89），而30个种族中有8个种族的VBAC调整后的比值较高（AOR范围为1.18-2.11）。在过去5年中，亚洲/太平洋岛民母亲的调整后VBAC率较高（1.39，CI [1.21，1.60]），30个种族群体中有9个（范围为1.25-1.84）。只有巴西母亲有较低的利率（0.37，CI [0.27，0.50]），相对于自我认定的美国母亲。结论：详细的母亲种族比广泛的种族/民族类别更准确地解释了VBAC率的变化。建议改进我们的公共卫生数据基础设施，以获取详细的种族信息，以确定和解决差距，并提高孕产妇保健的质量。
Objective Our objective was to examine the likelihood of vaginal birth after cesarean (VBAC) for women in Massachusetts. Methods We used birth certificate data among term, singleton, vertex presentation births by repeat cesarean or VBAC to conduct logistic regression models to examine the likelihood of VBAC for women categorized into standard classifications of race and ethnicity and into 31 detailed ethnicities. Data were analyzed for the entire study period (1996-2010, N = 119,752) and for the last 5 years (2006-2010, N = 46,081). Results The adjusted odds of VBAC were lowest for non-Hispanic Black mothers (0.91, CI [0.85, 0.98]) and highest for Asian/Pacific Islander mothers (1.41, CI [1.31, 1.53]) relative to non-Hispanic White women. VBAC rates ranged from 5.8 % among Brazilians to 29.3 % among Cambodians. The adjusted odds of VBAC were lower for 7 of the 30 ethnic groups (range of AORs 0.40-0.89) and higher for 8 of the 30 ethnic groups (range of AORs 1.18-2.11) relative to self-identified American mothers. For the last 5 years, Asian/Pacific Islander mothers had a higher adjusted VBAC rate (1.39, CI [1.21, 1.60]), as did 9 of the 30 ethnic groups (range of 1.25-1.84). Only Brazilian mothers had lower rates (0.37, CI [0.27, 0.50]), relative to self-identified American mothers. Conclusions Detailed maternal ethnicity explains the variation in VBAC rates more precisely than broad race/ethnicity categories. Improvements in our public health data infrastructure to capture detailed ethnicity are recommended to identify and address disparities and improve the quality of maternity care.