Cargando…

Racial and Ethnic Disparities in Cesarean Delivery and Indications Among Nulliparous, Term, Singleton, Vertex Women

OBJECTIVE: To compare cesarean delivery rates and indications by race/ethnicity among nulliparous women with term, singleton, vertex presentation deliveries. METHODS: This is a retrospective cohort study of nulliparous women delivering term, singleton, vertex neonates at Kaiser Permanente Northern C...

Descripción completa

Detalles Bibliográficos
Autores principales: Okwandu, Ijeoma C., Anderson, Meredith, Postlethwaite, Debbie, Shirazi, Aida, Torrente, Sandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9249704/
https://www.ncbi.nlm.nih.gov/pubmed/34254270
http://dx.doi.org/10.1007/s40615-021-01057-w
_version_ 1784739645797433344
author Okwandu, Ijeoma C.
Anderson, Meredith
Postlethwaite, Debbie
Shirazi, Aida
Torrente, Sandra
author_facet Okwandu, Ijeoma C.
Anderson, Meredith
Postlethwaite, Debbie
Shirazi, Aida
Torrente, Sandra
author_sort Okwandu, Ijeoma C.
collection PubMed
description OBJECTIVE: To compare cesarean delivery rates and indications by race/ethnicity among nulliparous women with term, singleton, vertex presentation deliveries. METHODS: This is a retrospective cohort study of nulliparous women delivering term, singleton, vertex neonates at Kaiser Permanente Northern California from 1/1/2016 to 6/30/2017. Women with cesarean for elective, malpresentation, or previa were excluded. Multivariable logistic regression models adjusting for maternal, neonatal, and facility factors were used to assess the likelihood of cesarean by race/ethnicity. Further modeling was performed to examine odds of cesarean for the indications of failure to progress and fetal intolerance by race/ethnicity. RESULTS: The cohort of 16,587 racially/ethnically diverse women meeting inclusion and exclusion criteria consisted of 41.62% White, 27.73% Asian, 22.11% Hispanic, 5.32% Black, and 3.21% multiple race/other women. In adjusted logistic regression models, all race and ethnic categories had higher odds of cesarean deliveries in comparison to White women. Black women had the highest odds of cesarean delivery (adjusted OR [aOR] = 1.73, 95% CI: 1.45–2.06), followed by Asian (aOR = 1.59, 95% CI: 1.45–2.06), multiple race/other (aOR = 1.45, 95% CI: 1.17–1.80), and Hispanic (aOR = 1.43, 95% CI: 1.28–1.59) women. Compared with White women, Asian (aOR = 1.46, 95% CI: 1.22–1.74) and Hispanic (aOR = 1.25, 95% CI: 1.03–1.52) women had higher odds of failure to progress as the indication. Among women with failure to progress, Black (aOR = 0.50, 95% CI: 0.30–0.81), Hispanic (aOR = 0.68, 95% CI: 0.53–0.87), and Asian (aOR = 0.77, 95% CI: 0.61–0.96) women were less likely than White women to reach 10 cm dilation. Compared with White women, Black women were more likely to have cesarean delivery for fetal intolerance (aOR = 1.51, 95% CI: 1.10–2.07). Among women with fetal intolerance of labor, there were no significant differences by race/ethnicity for Apgar score or neonatal intensive care unit admission. CONCLUSIONS: Race/ethnicity was significantly associated with the odds of cesarean and indication. All other race/ethnicity groups had higher odds of cesarean compared with White women. Compared with White women, Black women had greater odds of fetal intolerance as an indication, while Hispanic and Asian women had greater odds of failure to progress. Maternal, neonate, and facility factors for cesarean delivery did not explain the observed disparities in cesarean delivery rates.
format Online
Article
Text
id pubmed-9249704
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Springer International Publishing
record_format MEDLINE/PubMed
spelling pubmed-92497042022-07-03 Racial and Ethnic Disparities in Cesarean Delivery and Indications Among Nulliparous, Term, Singleton, Vertex Women Okwandu, Ijeoma C. Anderson, Meredith Postlethwaite, Debbie Shirazi, Aida Torrente, Sandra J Racial Ethn Health Disparities Article OBJECTIVE: To compare cesarean delivery rates and indications by race/ethnicity among nulliparous women with term, singleton, vertex presentation deliveries. METHODS: This is a retrospective cohort study of nulliparous women delivering term, singleton, vertex neonates at Kaiser Permanente Northern California from 1/1/2016 to 6/30/2017. Women with cesarean for elective, malpresentation, or previa were excluded. Multivariable logistic regression models adjusting for maternal, neonatal, and facility factors were used to assess the likelihood of cesarean by race/ethnicity. Further modeling was performed to examine odds of cesarean for the indications of failure to progress and fetal intolerance by race/ethnicity. RESULTS: The cohort of 16,587 racially/ethnically diverse women meeting inclusion and exclusion criteria consisted of 41.62% White, 27.73% Asian, 22.11% Hispanic, 5.32% Black, and 3.21% multiple race/other women. In adjusted logistic regression models, all race and ethnic categories had higher odds of cesarean deliveries in comparison to White women. Black women had the highest odds of cesarean delivery (adjusted OR [aOR] = 1.73, 95% CI: 1.45–2.06), followed by Asian (aOR = 1.59, 95% CI: 1.45–2.06), multiple race/other (aOR = 1.45, 95% CI: 1.17–1.80), and Hispanic (aOR = 1.43, 95% CI: 1.28–1.59) women. Compared with White women, Asian (aOR = 1.46, 95% CI: 1.22–1.74) and Hispanic (aOR = 1.25, 95% CI: 1.03–1.52) women had higher odds of failure to progress as the indication. Among women with failure to progress, Black (aOR = 0.50, 95% CI: 0.30–0.81), Hispanic (aOR = 0.68, 95% CI: 0.53–0.87), and Asian (aOR = 0.77, 95% CI: 0.61–0.96) women were less likely than White women to reach 10 cm dilation. Compared with White women, Black women were more likely to have cesarean delivery for fetal intolerance (aOR = 1.51, 95% CI: 1.10–2.07). Among women with fetal intolerance of labor, there were no significant differences by race/ethnicity for Apgar score or neonatal intensive care unit admission. CONCLUSIONS: Race/ethnicity was significantly associated with the odds of cesarean and indication. All other race/ethnicity groups had higher odds of cesarean compared with White women. Compared with White women, Black women had greater odds of fetal intolerance as an indication, while Hispanic and Asian women had greater odds of failure to progress. Maternal, neonate, and facility factors for cesarean delivery did not explain the observed disparities in cesarean delivery rates. Springer International Publishing 2021-07-12 2022 /pmc/articles/PMC9249704/ /pubmed/34254270 http://dx.doi.org/10.1007/s40615-021-01057-w Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Okwandu, Ijeoma C.
Anderson, Meredith
Postlethwaite, Debbie
Shirazi, Aida
Torrente, Sandra
Racial and Ethnic Disparities in Cesarean Delivery and Indications Among Nulliparous, Term, Singleton, Vertex Women
title Racial and Ethnic Disparities in Cesarean Delivery and Indications Among Nulliparous, Term, Singleton, Vertex Women
title_full Racial and Ethnic Disparities in Cesarean Delivery and Indications Among Nulliparous, Term, Singleton, Vertex Women
title_fullStr Racial and Ethnic Disparities in Cesarean Delivery and Indications Among Nulliparous, Term, Singleton, Vertex Women
title_full_unstemmed Racial and Ethnic Disparities in Cesarean Delivery and Indications Among Nulliparous, Term, Singleton, Vertex Women
title_short Racial and Ethnic Disparities in Cesarean Delivery and Indications Among Nulliparous, Term, Singleton, Vertex Women
title_sort racial and ethnic disparities in cesarean delivery and indications among nulliparous, term, singleton, vertex women
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9249704/
https://www.ncbi.nlm.nih.gov/pubmed/34254270
http://dx.doi.org/10.1007/s40615-021-01057-w
work_keys_str_mv AT okwanduijeomac racialandethnicdisparitiesincesareandeliveryandindicationsamongnulliparoustermsingletonvertexwomen
AT andersonmeredith racialandethnicdisparitiesincesareandeliveryandindicationsamongnulliparoustermsingletonvertexwomen
AT postlethwaitedebbie racialandethnicdisparitiesincesareandeliveryandindicationsamongnulliparoustermsingletonvertexwomen
AT shiraziaida racialandethnicdisparitiesincesareandeliveryandindicationsamongnulliparoustermsingletonvertexwomen
AT torrentesandra racialandethnicdisparitiesincesareandeliveryandindicationsamongnulliparoustermsingletonvertexwomen