title: The relationship between indicators of socioeconomic status and cesarean section in public hospitals.
abstract: OBJECTIVE
  To assess the relationship between indicators of socioeconomic status and cesarean section in public hospitals that adopt standardized protocols of obstetrical care.
  
  
  METHODS
  This was a prospective cohort study conducted between May 2005 and January 2006 with 831 pregnant women recruited from 10 public primary care clinics in São Paulo, Brazil. Demographic and clinical characteristics were collected during pregnancy. The three main exposures were schooling, monthly family income per capita, and residential crowding. The main outcome was cesarean section at three public hospitals located in the area. Crude and adjusted risk ratios (RR), with 95% confidence intervals were calculated using Poisson regression with robust variance. We examined the effects of each exposure variable on cesarean section accounting for potential confounders by using four different models: crude, adjusted by mother's characteristics, by obstetrical complications, and by the other two indicators of socioeconomic status.
  
  
  RESULTS
  Among the 757 deliveries performed in the public hospitals, 215 (28.4%) were by cesarean section. In the bivariate analysis, cesarean section was associated with higher family income per capita, higher education, lower residential crowding, pregnancy planning, white skin color, having a partner, and advanced maternal age. In the multivariate analysis, after adjustment for covariates, none of the socioeconomic status variables remained associated with cesarean section.
  
  
  CONCLUSIONS
  In this group, the chance of women undergoing cesarean section was not associated with indicators of socioeconomic status only, but was defined in accordance with major obstetric and clinical conditions.
authors.affiliation: Departamento de Medicina Preventiva. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Faisal-Cury
authors.affiliation: Departamento de Medicina Preventiva. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil.
authors.forename: Paulo Rossi
authors.initials: PR
authors.lastname: Menezes
authors.affiliation: Departamento de Medicina Preventiva. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil.
authors.forename: Julieta
authors.initials: J
authors.lastname: Quayle
authors.affiliation: Departamento de Medicina Preventiva. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil.
authors.forename: Kely
authors.initials: K
authors.lastname: Santiago
authors.affiliation: Departamento de Medicina Preventiva. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil.
authors.forename: Alicia
authors.initials: A
authors.lastname: Matijasevich
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D008423:Maternal Age; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications; D016012:Poisson Distribution; D011247:Pregnancy; D011248:Pregnancy Complications; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult