Maternal and Child Health Journal

, Volume 18, Issue 1, pp 250–257 | Cite as

Disparities in Cesarean Delivery by Ethnicity and Nativity in New York City

  • T. Janevic
  • E. Loftfield
  • D. A. Savitz
  • E. Bradley
  • J. Illuzzi
  • H. Lipkind
Article

Abstract

Our objective was to examine differences in risk of cesarean delivery among diverse ethnic groups in New York City. Using cross-sectional New York City birth and hospitalization data from 1995 to 2003 (n = 961,381) we estimated risk ratios for ethnic groups relative to non-Hispanic whites and immigrant women relative to US-born women. Adjusting for insurance, pre-pregnancy weight, maternal age, education, parity, birthweight, gestational age, year, medical complications, and pregnancy complications, all ethnic groups except East Asian women were at an increased risk of cesarean delivery, with the highest risk among Hispanic Caribbean women [adjusted risk ratio (aRR) = 1.27, 95 % CI (confidence interval) = 1.24, 1.30] and African American women (aRR = 1.20, 95 % CI = 1.17, 1.23). Among Hispanic groups, immigrant status further increased adjusted risk of cesarean delivery; adjusted risk ratios for foreign-born women compared to US-born women of the same ethnic group were 1.27 for Mexican women (95 % CI = 1.05, 1.53), 1.23 for Hispanic Caribbean women (95 % CI = 1.20, 1.27), and 1.12 for Central/South American women (95 % CI = 1.04, 1.21). Similar patterns were found in subgroup analyses of low-risk women (term delivery and no pregnancy or medical complications) and primiparous women. We found evidence of disparities by ethnicity and nativity in cesarean delivery rates after adjusting for multiple risk factors. Efforts to reduce rates of cesarean delivery should address these disparities. Future research should explore potential explanations including hospital environment, provider bias, and patient preference.

Keywords

Cesarean delivery Disparities Inequalities Immigrants Ethnicity 

References

  1. 1.
    Brennan, D. J., Robson, M. S., Murphy, M., & O’Herlihy, C. (2009). Comparative analysis of international cesarean delivery rates using 10-group classification identifies significant variation in spontaneous labor. American Journal of Obstetrics and Gynecology, 201(3), 308.PubMedCrossRefGoogle Scholar
  2. 2.
    Declercq, E., Menacker, F., MacDorman, M. (2006). Maternal risk profiles and the primary cesarean rate in the United States, 1991–2002. American Journal of Public Health, 96(5), 867–872.Google Scholar
  3. 3.
    MacDorman, M. F., Menacker, F., & Declercq, E. (2008). Cesarean birth in the United States: Epidemiology, trends, and outcomes. Clinics in Perinatology, 35(2), 293–307.PubMedCrossRefGoogle Scholar
  4. 4.
    Srinivas, S. K., Fager, C., & Lorch, S. A. (2010). Evaluating risk-adjusted cesarean delivery rate as a measure of obstetric quality. Obstetrics and Gynecology, 115(5), 1007.PubMedCrossRefGoogle Scholar
  5. 5.
    Bryant, A. S., Washington, S., Kuppermann, M., Cheng, Y. W., & Caughey, A. B. (2009). Quality and equality in obstetric care: Racial and ethnic differences in caesarean section delivery rates. Paediatric and Perinatal Epidemiology, 23(5), 454–462.PubMedCrossRefGoogle Scholar
  6. 6.
    Kabir, A. A., Pridjian, G., Steinmann, W. C., Herrera, E. A., & Khan, M. M. (2005). Racial differences in cesareans: An analysis of US 2001 national inpatient sample data. Obstetrics and Gynecology, 105(4), 710.PubMedCrossRefGoogle Scholar
  7. 7.
    Braveman, P., Egerter, S., Edmonston, F., & Verdon, M. (1995). Racial/ethnic differences in the likelihood of cesarean delivery, California. American Journal of Public Health, 85(5), 625.PubMedCrossRefGoogle Scholar
  8. 8.
    Aron, D. C., Gordon, H. S., DiGiuseppe, D. L., Harper, D. L., & Rosenthal, G. E. (2000). Variations in risk-adjusted cesarean delivery rates according to race and health insurance. Medical Care, 38(1), 35.PubMedCrossRefGoogle Scholar
  9. 9.
    Irwin, D. E., Savitz, D. A., Bowes, W. A., & St André, K. A. (1996). Race, age, and cesarean delivery in a military population*. Obstetrics and Gynecology, 88(4), 530–533.PubMedCrossRefGoogle Scholar
  10. 10.
    Washington, S., Caughey, A. B., Cheng, Y. W., & Bryant, A. S. (2012). Racial and ethnic differences in indication for primary cesarean delivery at term: Experience at one US institution. Birth, 39(2), 128–134.PubMedCrossRefGoogle Scholar
  11. 11.
    Chung, J. H., Garite, T. J., Kirk, A. M., Hollard, A. L., Wing, D. A., & Lagrew, D. C. (2006). Intrinsic racial differences in the risk of cesarean delivery are not explained by differences in caregivers or hospital site of delivery. Obstetrics and Gynecology, 194(5), 1323–1328.Google Scholar
  12. 12.
    Zlot, A. I., Jackson, D. J., & Korenbrot, C. (2005). Association of acculturation with cesarean section among latinas. Maternal and Child Health Journal, 9(1), 11–20.PubMedCrossRefGoogle Scholar
  13. 13.
    Savitz, D. A., Janevic, T. M., Engel, S. M., Kaufman, J. S., & Herring, A. H. (2008). Ethnicity and gestational diabetes in New York city, 1995–2003. BJOG, 115(8), 969–978.PubMedCrossRefGoogle Scholar
  14. 14.
    Janevic, T., Stein, C., Savitz, D., Kaufman, J., Mason, S., & Herring, A. (2010). Neighborhood deprivation and adverse birth outcomes among diverse ethnic groups. Annals of Epidemiology, 20(6), 445–451.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Yasmeen, S., Romano, P. S., Schembri, M. E., Keyzer, J. M., & Gilbert, W. M. (2006). Accuracy of obstetric diagnoses and procedures in hospital discharge data. American Journal of Obstetrics and Gynecology, 194(4), 992–1001.PubMedCrossRefGoogle Scholar
  16. 16.
    Rosenberg, T. J., Garbers, S., Lipkind, H., & Chiasson, M. A. (2005). Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: Differences among 4 racial/ethnic groups. American Journal of Public Health, 95(9), 1545–1551.PubMedCrossRefGoogle Scholar
  17. 17.
    Spiegelman, D., & Hertzmark, E. (2005). Easy SAS calculations for risk or prevalence ratios and differences. American Journal of Epidemiology, 162(3), 199–200.PubMedCrossRefGoogle Scholar
  18. 18.
    Huesch, M. D. (2011). Association between type of health insurance and elective cesarean deliveries: New Jersey, 2004–2007. American Journal of Public Health, 101(11), e1–e7.Google Scholar
  19. 19.
    Stein, C. R., Savitz, D. A., Janevic, T., Ananth, C. V., Kaufman, J. S., Herring, A. H., et al. (2009). Maternal ethnic ancestry and adverse perinatal outcomes in New York City. American Journal of Obstetrics and Gynecology, 201(6), 584.e1–584.e9.Google Scholar
  20. 20.
    Smedley, B. D., & Stith, A. Y. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: Natl Academy Press.Google Scholar
  21. 21.
    Lipkind, H. S., Duzyj, C., Rosenberg, T. J., Funai, E. F., Chavkin, W., & Chiasson, M. A. (2009). Disparities in cesarean delivery rates and associated adverse neonatal outcomes in New York City hospitals. Obstetrics and Gynecology, 113(6), 1239–1247.PubMedGoogle Scholar
  22. 22.
    Dovidio, J. F., Penner, L. A., Albrecht, T. L., Norton, W. E., Gaertner, S. L., & Shelton, J. N. (2008). Disparities and distrust: The implications of psychological processes for understanding racial disparities in health and health care. Social Science and Medicine, 67(3), 478–486.PubMedCrossRefGoogle Scholar
  23. 23.
    van Ryn, M., Burgess, D., Dovidio, J., Phelan, S., Saha, S., Malat, J., et al. (2011). The impact of racism on clinician cognition, behavior, and clinical decision making. Du Bois Review, 8(1), 199.CrossRefGoogle Scholar
  24. 24.
    Barber, E. L., Lundsberg, L. S., Belanger, K., Pettker, C. M., Funai, E. F., & Illuzzi, J. L. (2011). Indications contributing to the increasing cesarean delivery rate. Obstetrics and Gynecology, 118(1), 29–38.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Khunpradit, S., Tavender, E., Lumbiganon, P., Laopaiboon, M., Wasiak, J., & Gruen, R. L. (2011). Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database of Systematic Reviews, (6):CD005528. doi:10.1002/14651858.CD005528.pub2.

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • T. Janevic
    • 1
  • E. Loftfield
    • 2
  • D. A. Savitz
    • 3
  • E. Bradley
    • 2
  • J. Illuzzi
    • 4
  • H. Lipkind
    • 4
  1. 1.Department of EpidemiologyUMDNJ School of Public HealthPiscatawayUSA
  2. 2.School of Public HealthYale UniversityNew HavenUSA
  3. 3.Departments of Epidemiology and Obstetrics and GynecologyBrown UniversityProvidenceUSA
  4. 4.Department of Obstetrics, Gynecology & Reproductive SciencesYale University School of MedicineNew HavenUSA

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