Racial and ethnic disparities in the trends in primary cesarean delivery based on indications.
OBJECTIVE
To examine trends in primary cesarean deliveries by indications and race/ethnicity.


METHODS
We examined temporal trends in primary cesarean deliveries from 1991 through 2008 among singleton births (n = 540,953) in Kaiser Permanente Southern California hospitals using information from maternal hospitalizations and infant birth certificates. In addition, relative increases and 95% confidence intervals (CIs) were used to estimate differences in primary cesarean section rates by indication for the earliest (1991-1992) and most recent (2007-2008) periods. Racial/ethnic disparities in primary cesarean deliveries were examined by comparing the relative risks from multiple logistic regression models.


RESULTS
The rate of primary cesarean section among white, African American, Hispanic, and Asian/Pacific Islander women increased by 61.6%, 64.1%, 62.4%, and 70.2%, respectively, between 1991 and 2008. In comparison to the primary cesarean section rate for white women, the rate was 25% (95% confidence interval [CI], 22-29%) higher for African American women, 19% (95% CI, 16-23%) higher for Asian/Pacific Islander women, but 14% (95% CI, 13-16%) lower for Hispanic women. After adjustment for confounding factors, primary cesarean section rates remained significantly higher for African American women but lower for Hispanic women compared with white women. Indication subtypes-specific rates of primary cesarean section varied markedly across race/ethnicity.


CONCLUSIONS
We found that the overall primary cesarean section rate has increased over time. In addition, there is a wide variability in rate of indications for primary cesarean section by race/ethnicity.
Getahun
Darios
D
Department of Research and Evaluation, West Los Angeles Medical Center, Kaiser Permanente Southern California, Pasadena, CA, USA. Darios.T.Getahun@kp.org
Strickland
Daniel
D
Lawrence
Jean M
JM
Fassett
Michael J
MJ
Koebnick
Corinna
C
Jacobsen
Steven J
SJ
D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data / Q000639:trends*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D011247:Pregnancy; D044465:White People / Q000706:statistics & numerical data