Factors associated with increased cesarean risk among African American women: Evidence from California, 2010

Marco Huesch, Jason N. Doctor

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)956-962
Number of pages7
JournalAmerican journal of public health
Volume105
Issue number5
DOIs
StatePublished - May 1 2015

Fingerprint

African Americans
Risk Adjustment
Patient Preference
Health Status
Cluster Analysis
Comorbidity
Emergencies
Odds Ratio
Mothers
Physicians

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health

Cite this

@article{fe43416c5b704b0b8f6e9500b0c87d93,
title = "Factors associated with increased cesarean risk among African American women: Evidence from California, 2010",
abstract = "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.",
author = "Marco Huesch and Doctor, {Jason N.}",
year = "2015",
month = "5",
day = "1",
doi = "10.2105/AJPH.2014.302381",
language = "English (US)",
volume = "105",
pages = "956--962",
journal = "American Journal of Public Health",
issn = "0090-0036",
publisher = "American Public Health Association Inc.",
number = "5",

}

Factors associated with increased cesarean risk among African American women : Evidence from California, 2010. / Huesch, Marco; Doctor, Jason N.

In: American journal of public health, Vol. 105, No. 5, 01.05.2015, p. 956-962.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Factors associated with increased cesarean risk among African American women

T2 - Evidence from California, 2010

AU - Huesch, Marco

AU - Doctor, Jason N.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84926686922&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84926686922&partnerID=8YFLogxK

U2 - 10.2105/AJPH.2014.302381

DO - 10.2105/AJPH.2014.302381

M3 - Article

C2 - 25790391

AN - SCOPUS:84926686922

VL - 105

SP - 956

EP - 962

JO - American Journal of Public Health

JF - American Journal of Public Health

SN - 0090-0036

IS - 5

ER -