title: Intrinsic racial differences in the risk of cesarean delivery are not explained by differences in caregivers or hospital site of delivery.
abstract: OBJECTIVE
  This study was undertaken to assess whether racial differences in the risk of cesarean delivery result from differing practices of their caregivers or the hospitals at which they deliver.
  
  
  METHODS
  A retrospective cohort study was performed using the Perinatal Database of the Memorial Health Care System. Logistic regression was used to estimate the risk of primary cesarean delivery among patients eligible for labor. The contribution of hospital and physician level cluster correlation was evaluated using fixed and random effects regression models.
  
  
  RESULTS
  Compared with white patients, black and Hispanic patients were 75% and 22% more likely to undergo primary cesarean delivery. Further adjustment for hospital and physician level cluster correlation resulted in persistently increased risks of primary cesarean delivery in black (54%) and Hispanic patients (12%).
  
  
  CONCLUSIONS
  Hospital site of delivery and individual physician practices do not fully explain racial differences in the risk of primary cesarean delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Women's Hospital, Long Beach Memorial Medical Center, Long Beach, CA 90806, USA. judithc@uci.edu
authors.forename: Judith H
authors.initials: JH
authors.lastname: Chung
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Garite
authors.forename: Adele M
authors.initials: AM
authors.lastname: Kirk
authors.forename: Amie L
authors.initials: AL
authors.lastname: Hollard
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Wing
authors.forename: David C
authors.initials: DC
authors.lastname: Lagrew
mesh_terms: D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D017028:Caregivers; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D011247:Pregnancy; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D044465:White People / Q000706:statistics & numerical data