Disparities in cesarean delivery rates and associated adverse neonatal outcomes in New York City hospitals.
OBJECTIVE
To examine the primary cesarean delivery rates and associated neonatal outcomes by insurance status in public and private hospitals in New York City.


METHODS
We accessed Vital statistics data on all births to women with Medicaid or private insurance from 1996 through 2003, compiling a total of 321,308 nulliparous women who delivered singleton neonates by either normal spontaneous vaginal delivery or primary cesarean delivery. Rates of primary cesarean delivery and adverse neonatal outcomes were examined by hospital type and insurance status while controlling for potential confounders.


RESULTS
There were 51,682 and 269,626 women who delivered in public hospitals and private hospitals, respectively. The cesarean delivery rate of women with private insurance delivering in private hospitals was 30.4% compared with a cesarean rate of 21.2% in Medicaid patients delivering in public hospitals (adjusted odds ratio [OR] 1.57, 95% confidence interval [CI] 1.53-1.63). The percent of infants born to women with private insurance and Medicaid delivering in private hospitals with a 5-minute Apgar score less than 7 was 0.6% and 0.8% compared with 1.0% of infants delivering in the public hospital system (adjusted OR 0.59, 95% CI 0.51- 0.68 and adjusted OR 0.73, 95% CI 0.65- 0.82). The neonatal intensive care unit admission rate was also lower in neonates born in private hospitals at 6.7% and 8.5% compared with a 12.8% admission rate in public hospitals (adjusted OR 0.48, 95% CI 0.46-0.51 and adjusted OR 0.59, 95% CI 0.57- 0.62 after controlling for mode of delivery).


CONCLUSIONS
Even when controlling for confounders, there was an association between primary cesarean delivery and insurance status regardless of hospital type. There was also a higher risk of adverse neonatal outcomes in the public hospitals regardless of mode of delivery.


METHODS
III.
Lipkind
Heather S
HS
From the Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut; Public Health Solutions, New York, New York; and the Mailman School of Public Health, Columbia University, New York, New York.
Duzyj
Christina
C
Rosenberg
Terry J
TJ
Funai
Edmund F
EF
Chavkin
Wendy
W
Chiasson
Mary Ann
MA
D000293:Adolescent; D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D007348:Insurance, Health; D008484:Medicaid; D009519:New York City / Q000453:epidemiology; D011247:Pregnancy; D014481:United States / Q000453:epidemiology; D014798:Vital Statistics