Race, age, and cesarean delivery in a military population.
OBJECTIVE
To evaluate the relationship between race, age, and the risk of cesarean delivery.


METHODS
This was a cohort study of 3603 nulliparous enlisted United States Navy women who were on active duty and had a singleton delivery between October 1987 and September 1989. Type of delivery and complications of pregnancy, labor, or delivery were identified through hospital discharge diagnoses codes. Demographic risk factors were obtained from military personnel files.


RESULTS
Women over age 30 had a significantly increased risk of cesarean delivery (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.1-1.9) compared with women under age 30. Multiple logistic regression modeling adjusted for education, marital status, military rank, type of hospital, and complications of pregnancy, labor and delivery showed African-American women over age 30 to have a significantly increased risk for cesarean delivery (OR 2.2, 95% CI 1.1-4.2) compared with white women over age 30. Among women under 30, African-Americans were not at a greater risk of cesarean delivery (OR 1.1; 95% CI 0.89-1.3). Other demographic factors were not related to the risk of cesarean delivery, but complications of pregnancy, labor, and delivery were strong predictors.


CONCLUSIONS
We observed an increased risk in this unique population over age 30. Active duty military women serve as a useful population to examine demographic differences because of equitable access to medical care.
Irwin
D E
DE
Department of Epidemiology, University of North Carolina, Chapel Hill, USA.
Savitz
D A
DA
Bowes
W A
WA
St André
K A
KA
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D016015:Logistic Models; D017533:Marital Status; D008423:Maternal Age; D008889:Military Personnel / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*