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种族差异的医院一级变化,低风险的零分娩剖腹产产率的变化
Elliott K Main1, Shen-Chih Chang2, Curisa M Tucker3
1California Maternal Quality Care Collaborative, Stanford, CA (Drs Main and Chang, Ms Sakowski, and Drs Leonard and Rosenstein); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Main and Leonard).
American journal of obstetrics & gynecology MFM
|August 30, 2023
概括
黑人患者面临更高的剖腹产率,医院的差异很大. 这种因患者或医院因素而无法解释的差异表明剖腹产分娩决策可能存在偏见.
科学领域:
- 产科和妇科 产科和妇科
- 健康 公平 研究 健康 公平 研究
- 公共卫生 公共卫生
背景情况:
- 在全国范围内,黑人患者的剖腹产率不成比例地高,这是最近的趋势,扭转了以前的模式.
- 在数据汇总时,剖腹产率的医院一级变化掩盖了显著的种族差异.
- 了解这些不平等对于解决孕产妇医疗保健中的种族差异至关重要.
研究的目的:
- 调查黑人和白人患者之间的首胎剖腹产率种族差异背后的原因.
- 分析不同种族/种族群体中首胎剖腹产率的医院水平变化.
- 确定特定的医院或患者特征,可能解释观察到的种族差异.
主要方法:
- 一项人口横截面研究分析了加利福尼亚州1,267,493名活产儿 (2018-2020年),使用链接的出生证明和产妇出院数据.
- 按种族/族裔和医院计算的年度无双期单头顶剖腹产 (首次分娩) 率.
- 医院之间的患者和医院特征的比较,在黑人患者中,初生剖腹产率低 (<23.9%) 和高 (≥23.9%).
主要成果:
- 黑人患者的首次剖腹产分娩率显著更高 (28.4%),与其他种族群体相比,变化更大.
- 对于黑人患者来说,剖腹产率低的医院 (19.9%) 与高率医院 (30.7%) 相比,在设施或患者特征上没有显著差异.
- 在不达到目标率的医院的黑人患者中,观察到主观剖腹产指示的更高率 (例如,产痛,胎儿担忧).
结论:
- 黑人患者的第一次分娩剖腹产率存在显著的医院级差异,超过其他群体.
- 患者或医院因素中没有可识别的差异,这表明无意识的偏见和结构性种族主义有助于剖腹产的种族差异.
- 需要有针对性的干预措施来解决导致黑人母亲剖腹产不平等的系统因素.
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