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A Cross-Sectional Study Examining Differences in Indication for Cesarean Delivery by Race/Ethnicity
Rebecca Delafield1, Jennifer Elia2, Ann Chang2
1Thompson School of Social Work & Public Health, Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI 96822, USA.
Healthcare (Basel, Switzerland)
|February 6, 2021
Summary
Micronesian women in Hawaii experience higher cesarean delivery rates, particularly for subjective reasons like non-reassuring fetal heart tracing. This suggests potential provider bias may influence delivery decisions.
Area of Science:
- Maternal-fetal medicine
- Health disparities research
- Medical sociology
Background:
- Racial and ethnic disparities in cesarean delivery persist in the U.S.
- Causes of these disparities, including potential provider bias, are not fully understood.
- Micronesian women, a recent migrant group in Hawaii, exhibit higher cesarean delivery rates compared to White women.
Purpose of the Study:
- To investigate factors contributing to cesarean delivery disparities between Micronesian and White women in Hawaii.
- To examine the role of subjective versus objective medical indications for cesarean delivery.
- To explore the potential influence of provider bias on cesarean delivery recommendations.
Main Methods:
- Retrospective chart review of 620 cesarean deliveries (296 White, 324 Micronesian) at Hawaii's largest maternity hospital.
- Multivariate regression models analyzed associations between maternal/obstetric characteristics and cesarean indications.
- Indications were categorized as subjective (e.g., non-reassuring fetal heart tracing, arrest of labor) or objective (e.g., malpresentation).
Main Results:
- Micronesian women had significantly higher odds of cesarean delivery due to subjective indications compared to White women (aOR: 4.17; CI: 2.52-6.88; P < 0.001).
- This association remained significant after adjusting for multiple covariates.
- No significant differences were found for objective indications (data not shown).
Conclusions:
- Findings suggest unmeasured factors, potentially provider bias, influence cesarean delivery recommendations for Micronesian women.
- Addressing provider bias is crucial for reducing cesarean delivery disparities.
- Further research is needed to elucidate the specific mechanisms of bias.
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