title: Comparison of Primary Cesarean Delivery Rates Among Low-Risk Women in Urban and Rural Hospitals in Hawaii.
abstract: Objective The purpose of this study was to examine primary cesarean delivery rates among women with low risk pregnancies in urban and rural hospitals in Hawaii. Methods This is a retrospective study of all low-risk women (term, vertex, singleton) who had a primary cesarean delivery in any Hawaii hospital from 2010 to 2011 using a statewide health information database. Hospitals were divided into two categories: rural and urban. Results Of the 27,096 women who met criteria for this study, 7105 (26.2 %) delivered in a rural hospital. Low-risk women who delivered in a rural hospital had a primary cesarean delivery rate of 18.5 % compared to 11.8 % in the urban hospitals, p < .0001. Low-risk women who delivered at rural hospitals had significantly higher unadjusted and adjusted odds ratios for cesarean delivery. The association with rural hospital was stronger after adjusting for confounders, aOR 2.47 (95 % CI 2.23-2.73) compared to unadjusted OR 1.70 (95 % CI 1.58-1.83) for primary cesarean delivery. Conclusions on practice In a geographically isolated population, rates of primary cesarean delivery among low-risk women are significantly higher in rural hospitals. This disparity should be investigated further.
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, University of Hawaii, 1319 Punahou Street Suite #824, Honolulu, HI, 96826, USA. annchang@hawaii.edu.
authors.forename: Ann Lee
authors.initials: AL
authors.lastname: Chang
authors.affiliation: Department of Kinesiology and Exercise Science, University of Hawaii at Hilo, 200 West Kawili Street, Hilo, HI, 96720, USA.
authors.forename: Misty
authors.initials: M
authors.lastname: Pacheco
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, University of Hawaii, 1319 Punahou Street Suite #824, Honolulu, HI, 96826, USA.
authors.forename: Kurt
authors.initials: K
authors.lastname: Yoshino
authors.affiliation: Hawaii Health Information Corporation, 733 Bishop Street, Suite 1870, Honolulu, HI, 96813, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Miyamura
authors.affiliation: School of Public Health, Texas A&M Health Science Center, 212 Adriance Lab Road, College Station, TX, 77843-1266, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Maddock
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Geographic disparity; Primary cesarean section; Rural