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Hospital variations in caesarean delivery rates: An analysis of national data in China, 2016-2020
BACKGROUND: The impact of China’s use of caesarean delivery on global public health has been a long-term concern. The number of private hospitals is increasing in China and likely driving up caesarean delivery rates, yet specifics remain unknown. We aimed to investigate variations in caesarean deliv...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Society of Global Health
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10078857/ https://www.ncbi.nlm.nih.gov/pubmed/37022716 http://dx.doi.org/10.7189/jogh.13.04029 |
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author | Yin, Shaohua Zhou, Yubo Yuan, Pengbo Wei, Yuan Chen, Lian Guo, Xiaoyue Li, Hongtian Lu, Jie Ge, Lin Shi, Huifeng Wang, Xiaoxia Li, Luyao Qiao, Jie Chen, Dunjin Liu, Jianmeng Zhao, Yangyu |
author_facet | Yin, Shaohua Zhou, Yubo Yuan, Pengbo Wei, Yuan Chen, Lian Guo, Xiaoyue Li, Hongtian Lu, Jie Ge, Lin Shi, Huifeng Wang, Xiaoxia Li, Luyao Qiao, Jie Chen, Dunjin Liu, Jianmeng Zhao, Yangyu |
author_sort | Yin, Shaohua |
collection | PubMed |
description | BACKGROUND: The impact of China’s use of caesarean delivery on global public health has been a long-term concern. The number of private hospitals is increasing in China and likely driving up caesarean delivery rates, yet specifics remain unknown. We aimed to investigate variations in caesarean delivery rates across and within hospital types in China. METHODS: We retrieved data on hospital characteristics and national hospital-level annually aggregated data on the number of deliveries and caesarean deliveries from 2016-2020, covering 7085 hospitals in 31 provinces of mainland China, from the National Clinical Improvement System. We categorized hospitals as public-non-referral (n = 4103), public-referral (n = 1805) and private (n = 1177). Among the private hospitals, 89.1% (n = 1049) were non-referral regarding obstetrical services for uncomplicated pregnancies. RESULTS: Among 38 517 196 deliveries, 16 744 405 were caesarean, giving an overall rate of 43.5% with a minor range of 42.9%-43.9% over time. Median rates differed across hospital types, from 47.0% (interquartile range (IQR) = 39.8%-55.9%) in public-referral, 45.8% (36.2%-55.8%) in private, and 40.3% (30.6%-50.6%) in public-non-referral hospitals. The stratified analyses corroborated the results, except for the northeastern region, where the median rates did not differ across the public-non-referral (58.9%), public-referral (59.3%), and private (58.8%) hospitals, while all ranked higher than the other regions, regardless of hospital type and urbanization levels. The rates within hospital types differed as well, especially in the rural areas of the western region of China, where the difference of rates between the 5th and 95th percentiles was 55.6% (IQR = 4.9%-60.5%) in public-non-referral, 51.5% (IQR = 19.6%-71.1%) in public-referral, and 64.6% (IQR = 14.8%-79.4%) in private hospitals. CONCLUSIONS: Variation across hospital types in China was pronounced, with the highest rates either in public-referral or private hospitals, except in the northeastern region, where no variation was observed among the high rates of caesarean deliveries. Variation within each hospital type was pronounced, especially in rural areas of the western region. |
format | Online Article Text |
id | pubmed-10078857 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | International Society of Global Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-100788572023-04-07 Hospital variations in caesarean delivery rates: An analysis of national data in China, 2016-2020 Yin, Shaohua Zhou, Yubo Yuan, Pengbo Wei, Yuan Chen, Lian Guo, Xiaoyue Li, Hongtian Lu, Jie Ge, Lin Shi, Huifeng Wang, Xiaoxia Li, Luyao Qiao, Jie Chen, Dunjin Liu, Jianmeng Zhao, Yangyu J Glob Health Articles BACKGROUND: The impact of China’s use of caesarean delivery on global public health has been a long-term concern. The number of private hospitals is increasing in China and likely driving up caesarean delivery rates, yet specifics remain unknown. We aimed to investigate variations in caesarean delivery rates across and within hospital types in China. METHODS: We retrieved data on hospital characteristics and national hospital-level annually aggregated data on the number of deliveries and caesarean deliveries from 2016-2020, covering 7085 hospitals in 31 provinces of mainland China, from the National Clinical Improvement System. We categorized hospitals as public-non-referral (n = 4103), public-referral (n = 1805) and private (n = 1177). Among the private hospitals, 89.1% (n = 1049) were non-referral regarding obstetrical services for uncomplicated pregnancies. RESULTS: Among 38 517 196 deliveries, 16 744 405 were caesarean, giving an overall rate of 43.5% with a minor range of 42.9%-43.9% over time. Median rates differed across hospital types, from 47.0% (interquartile range (IQR) = 39.8%-55.9%) in public-referral, 45.8% (36.2%-55.8%) in private, and 40.3% (30.6%-50.6%) in public-non-referral hospitals. The stratified analyses corroborated the results, except for the northeastern region, where the median rates did not differ across the public-non-referral (58.9%), public-referral (59.3%), and private (58.8%) hospitals, while all ranked higher than the other regions, regardless of hospital type and urbanization levels. The rates within hospital types differed as well, especially in the rural areas of the western region of China, where the difference of rates between the 5th and 95th percentiles was 55.6% (IQR = 4.9%-60.5%) in public-non-referral, 51.5% (IQR = 19.6%-71.1%) in public-referral, and 64.6% (IQR = 14.8%-79.4%) in private hospitals. CONCLUSIONS: Variation across hospital types in China was pronounced, with the highest rates either in public-referral or private hospitals, except in the northeastern region, where no variation was observed among the high rates of caesarean deliveries. Variation within each hospital type was pronounced, especially in rural areas of the western region. International Society of Global Health 2023-04-07 /pmc/articles/PMC10078857/ /pubmed/37022716 http://dx.doi.org/10.7189/jogh.13.04029 Text en Copyright © 2023 by the Journal of Global Health. All rights reserved. https://creativecommons.org/licenses/by/4.0/This work is licensed under a Creative Commons Attribution 4.0 International License. |
spellingShingle | Articles Yin, Shaohua Zhou, Yubo Yuan, Pengbo Wei, Yuan Chen, Lian Guo, Xiaoyue Li, Hongtian Lu, Jie Ge, Lin Shi, Huifeng Wang, Xiaoxia Li, Luyao Qiao, Jie Chen, Dunjin Liu, Jianmeng Zhao, Yangyu Hospital variations in caesarean delivery rates: An analysis of national data in China, 2016-2020 |
title | Hospital variations in caesarean delivery rates: An analysis of national data in China, 2016-2020 |
title_full | Hospital variations in caesarean delivery rates: An analysis of national data in China, 2016-2020 |
title_fullStr | Hospital variations in caesarean delivery rates: An analysis of national data in China, 2016-2020 |
title_full_unstemmed | Hospital variations in caesarean delivery rates: An analysis of national data in China, 2016-2020 |
title_short | Hospital variations in caesarean delivery rates: An analysis of national data in China, 2016-2020 |
title_sort | hospital variations in caesarean delivery rates: an analysis of national data in china, 2016-2020 |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10078857/ https://www.ncbi.nlm.nih.gov/pubmed/37022716 http://dx.doi.org/10.7189/jogh.13.04029 |
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