title: Disparities in cesarean delivery by ethnicity and nativity in New York city.
abstract: Our objective was to examine differences in risk of cesarean delivery among diverse ethnic groups in New York City. Using cross-sectional New York City birth and hospitalization data from 1995 to 2003 (n = 961,381) we estimated risk ratios for ethnic groups relative to non-Hispanic whites and immigrant women relative to US-born women. Adjusting for insurance, pre-pregnancy weight, maternal age, education, parity, birthweight, gestational age, year, medical complications, and pregnancy complications, all ethnic groups except East Asian women were at an increased risk of cesarean delivery, with the highest risk among Hispanic Caribbean women [adjusted risk ratio (aRR) = 1.27, 95 % CI (confidence interval) = 1.24, 1.30] and African American women (aRR = 1.20, 95 % CI = 1.17, 1.23). Among Hispanic groups, immigrant status further increased adjusted risk of cesarean delivery; adjusted risk ratios for foreign-born women compared to US-born women of the same ethnic group were 1.27 for Mexican women (95 % CI = 1.05, 1.53), 1.23 for Hispanic Caribbean women (95 % CI = 1.20, 1.27), and 1.12 for Central/South American women (95 % CI = 1.04, 1.21). Similar patterns were found in subgroup analyses of low-risk women (term delivery and no pregnancy or medical complications) and primiparous women. We found evidence of disparities by ethnicity and nativity in cesarean delivery rates after adjusting for multiple risk factors. Efforts to reduce rates of cesarean delivery should address these disparities. Future research should explore potential explanations including hospital environment, provider bias, and patient preference.
authors.affiliation: Department of Epidemiology, UMDNJ School of Public Health, 683 Hoes Lane West, Room 209, PO Box 9, Piscataway, NJ, 08854, USA. janevite@umdnj.edu.
authors.forename: T
authors.initials: T
authors.lastname: Janevic
authors.affiliation: School of Public Health, Yale University, New Haven, CT, USA.
authors.forename: E
authors.initials: E
authors.lastname: Loftfield
authors.affiliation: Departments of Epidemiology and Obstetrics and Gynecology, Brown University, Providence, RI, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Savitz
authors.affiliation: School of Public Health, Yale University, New Haven, CT, USA.
authors.forename: E
authors.initials: E
authors.lastname: Bradley
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: J
authors.initials: J
authors.lastname: Illuzzi
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: H
authors.initials: H
authors.lastname: Lipkind
mesh_terms: D001719:Birth Certificates; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008423:Maternal Age; D008498:Medical Record Linkage; D054525:Minority Health / Q000208:ethnology* / Q000706:statistics & numerical data; D009519:New York City / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology*; D011256:Pregnancy Outcome / Q000208:ethnology*; D012307:Risk Factors; D012959:Socioeconomic Factors