title: [Caesarean delivery in Andalusia, Spain: relationship with social, clinical and health services factors (2007-2009)].
abstract: BACKGROUND
  Increasing trend and geographical variations in the use of caesarean section suggest the influence of non-clinical factors. The objective was to describe the use of caesarean section in the Andalusian region in Spain by exploring the role of social, clinical, and health services variables.
  
  
  METHODS
  A cross-sectional study was carried out using vital statistics. It involves all births occurred in Andalusia during the period of 2007-2009. The dependent variable was the use of caesarean section and the set of covariates were classified into three groups: those with a clinical meaning, those related to the health services organization, and those with a social significance. Multivariate logistic regressions were used.
  
  
  RESULTS
  In the data set of 293,558 births, the prevalence of caesarean delivery was 24.8%. The multivariate analysis highlights the labour complications as the clinical variable with the highest odds ratio (OR=19.36). Regarding the health services variables, the odds of experiencing a caesarean delivery were 55% higher on weekdays than on weekends. Cádiz was the province with the highest OR for caesarean section (comparison between Cádiz and Almería: OR=1,21) where the ratio between births in public and private hospitals was 3.7. The frequency of caesarean section was 34% higher in women with third level education than those with no education.
  
  
  CONCLUSIONS
  Labour complication is the most influential variable for caesarean section. Caesarean birth rate is above the accepted standards for all social classes and increases with educational level. Inter-provincial differences reflect different patterns with regard to the use of private medicine.
authors.affiliation: Secretaría General de Salud Pública y Participación, Consejería de Salud de Junta de Andalucía, Sevilla. soledadm.marquez@juntadeandalucia.es
authors.forename: Soledad
authors.initials: S
authors.lastname: Márquez-Calderón
authors.forename: Miguel
authors.initials: M
authors.lastname: Ruiz-Ramos
authors.forename: Sol
authors.initials: S
authors.lastname: Juárez
authors.forename: Julián
authors.initials: J
authors.lastname: Librero López
mesh_terms: D000328:Adult; D000367:Age Factors; D001719:Birth Certificates; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D004522:Educational Status; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D007744:Obstetric Labor Complications; D016017:Odds Ratio; D011247:Pregnancy; D013030:Spain; D013997:Time Factors