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Factors associated with increased cesarean risk among African American women: evidence from California, 2010
1Marco Huesch is with the Sol Price School of Public Policy and the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California (USC), Los Angeles. At the time of the study, he was also with the Department of Community and Family Medicine, Duke University School of Medicine, and the Duke University Fuqua School of Business, Durham, NC. Jason N. Doctor is with the School of Pharmacy and the Leonard D. Schaeffer Center for Health Policy and Economics, USC.
Objectives:
We studied if both observed and unobserved maternal health in African American women in hospitals or communities were associated with cesarean delivery of infants.
Methods:
We examined the relationship between African American race and cesarean delivery among 493 433 women discharged from 255 Californian hospitals in 2010 using administrative data; we adjusted for patient comorbidities and maternal, fetal, and placental risk factors, as well as clustering of patients within hospitals.
Results:
Cesarean rates were significantly higher overall for African American women than other women (unadjusted rate 36.8% vs 32.7%), as were both elective and emergency primary cesarean rates. Elevated risks persisted after risk adjustment (odds ratio generally > 1.27), but the prevalence of particular risk factors varied. Although African American women were clustered in some hospitals, the proportion of African Americans among all women delivering in a hospital was not related to its overall cesarean rate.
Conclusions:
To address the higher likelihood of elective cesarean delivery, attention needs to be given to currently unmeasured patient-level health factors, to the quality of provider-physician interactions, as well as to patient preferences.
