Systemic Hospital Effects Driving Racial Disparities in Non-Elective Cesarean Delivery: Evidence from the New York...

Area of Science:

• Obstetrics and Gynecology
• Health Disparities Research
• Healthcare Quality Improvement

Background:

• Non-Hispanic Black patients exhibit higher non-elective cesarean delivery rates compared to White patients.
• The extent to which observable factors versus unmeasured structural influences contribute to this disparity remains unclear.

Purpose of the Study:

• To quantify the racial disparity in non-elective cesarean delivery rates between Non-Hispanic Black and White patients.
• To decompose the cesarean delivery gap into explained and unexplained components using the Oaxaca Blinder method.

Main Methods:

• Analysis of 160,122 Non-Hispanic Black and White patients from New York State SPARCS data (2018-2022).
• Utilized chi-square tests for characteristic comparisons and Oaxaca Blinder decomposition for disparity analysis.

Main Results:

• Non-Hispanic Black patients had a cesarean rate of 37.8% versus 27.8% for White patients (10.0 percentage point difference).
• Observable factors explained only 7% of the disparity; unexplained effects accounted for 107%.
• Hospitals explained 40% of the unexplained disparity, indicating differential treatment within facilities.

Conclusions:

• Differential hospital treatment significantly contributes to the Black/White disparity in non-elective cesarean deliveries.
• Standardizing practices and ensuring equitable resource distribution across hospitals are crucial for reducing this gap.