Sage Journals: Discover world-class research

Abstract

Background

Disparities in obstetric care have been well documented, but disparities in the within-hospital population have not been as extensively explored. The objective is to assess cesarean delivery rate disparities at the hospital level in a nationally recognized low risk of cesarean delivery group.

Methods

An observational study using a national population-based database, Nationwide Inpatient Sample, from 2008 to 2011 was conducted. All patients with nulliparous, term, singleton, vertex pregnancies from Black and White patients were included. The primary outcome was delivery mode (cesarean vs vaginal). The primary independent variable was race (Black vs White).

Results

A total of 1,064,351 patients were included and the overall nulliparous, term, singleton, and vertex pregnancies cesarean delivery rate was 14.1%. The within-hospital disparities of cesarean delivery rates were lower in minority-serving hospitals (OR: 1.20 95% CI: 1.12-1.28), rural hospitals (OR 1.11 95% CI: 1.02-1.20), and the South (OR 1.24 95% CI 1.19-1.30) compared to their respective counterparts. Non-minority serving hospitals (OR: 1.20 95% CI 0.12-1.25), and urban hospitals (OR1.32 95% CI 1.28-1.37), the Northeast (OR 1.41 95% CI 1.30-1.53) or West (OR 1.52 95% CI 1.38-1.67), had higher within-hospital racial disparities of cesarean delivery rates. The odds ratios reported are comparing within-hospital cesarean delivery rates in Black and White patients.

Discussion

Significant within-hospital disparities of cesarean delivery rates across hospitals highlight the importance of facility-level factors. Policies aimed at advancing health equity must address hospital-level drivers of disparities in addition to structural racism.

Keywords

cesarean delivery health equity racial disparity racism urbanicity

Get full access to this article

View all access options for this article.

References

Howell

Egorova

Janevic

, et al. Race and ethnicity, medical insurance, and within-hospital severe maternal morbidity disparities. Obstet Gynecol. 2020;135(2):285-293. doi:10.1097/AOG.0000000000003667

Howell

Brown

Brumley

, et al. Reduction of Peripartum Racial and Ethnic Disparities: A Conceptual Framework and Maternal Safety Consensus Bundle. Obstetrics and Gynecology 2018;131(5):770-782. doi:10.1097/AOG.0000000000002475

Armstrong

Kozhimannil

McDermott

Saade

Srinivas

SK.

Society for Maternal-Fetal Medicine Health Policy Committee . Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures. Am J Obstet Gynecol. 2016;214(2):153-163. doi:10.1016/j.ajog.2015.10.935

Mistry

Fingar

Elixhauser

Variation in the Rate of Cesarean Section Across U.S. Hospitals, 2013. Agency for Healthcare Research and Quality. Published September 2016. https://hcup-us.ahrq.gov/reports/statbriefs/sb211-Hospital-Variation-C-sections-2013.jsp Accessed August 8, 2023.

Kuklina

Whiteman

Hillis

, et al. An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity. Matern Child Health J. 2008;12(4):469-477. doi:10.1007/s10995-007-0256-6

NTSV C-Sections Measure Specifications . California Maternal Quality Care Collaborative. https://www.cmqcc.org/focus-areas/quality-metrics/ntsv-c-sections-specifications. Accessed August 8, 2023.

Deyo

Cherkin

Ciol

. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613-619.

Healthcare Cost and Utilization Project (HCUP) . Agency for Healthcare Research and Quality. https://www.ahrq.gov/data/hcup/index.html. Accessed August 8, 2023.

Hardeman

Kheyfets

Mantha

Cornell

Crear-Perry

Graves

, et al. Developing tools to report racism in maternal health for the CDC maternal mortality review information application (MMRIA): findings from the MMRIA racism and discrimination working group. Matern Child Health J. 2022;26(4):661-669.

10.

Kozhimannil

Arcaya

Subramanian

. Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: analyses of a National US hospital discharge database. PLoS Med. 2014;11(10):e1001745. doi:10.1371/journal.pmed.1001745

11.

Butcher

Fos

Zuniga

Pane

. Racial variations in cesarean section rates: an analysis of Medicaid data in Louisiana. J Publ Health Manag Pract. 1997;3(2):41-48. doi:10.1097/00124784-199703000-00008

12.

Huesch

Doctor

. Factors associated with increased cesarean risk among african american women: evidence from California, 2010. Am J Publ Health. 2015;105(5):956-962. doi:10.2105/AJPH.2014.302381

13.

Stafford

. Cesarean section use and source of payment: an analysis of California hospital discharge abstracts. Am J Publ Health. 1990;80(3):313-315. doi:10.2105/ajph.80.3.313

14.

Howell

Egorova

Balbierz

Zeitlin

Hebert

. Site of delivery contribution to black-white severe maternal morbidity disparity. Am J Obstet Gynecol. 2016;215(2):143-152. doi:10.1016/j.ajog.2016.05.007

15.

Howell

Egorova

Balbierz

Zeitlin

Hebert

. Black-White differences in severe maternal morbidity and site of care. Am J Obstet Gynecol. 2016;214(1):122.e1. doi:10.1016/j.ajog.2015.08.019

16.

Roth

Henley

. Unequal motherhood: racial-ethnic and socioeconomic disparities in Cesarean Sections in the United States. Soc Probl. 2012;59(2):207-227. doi:10.1525/sp.2012.59.2.207

17.

Ayanian

Udvarhelyi

Gatsonis

Pashos

Epstein

. Racial differences in the use of revascularization procedures after coronary angiography. JAMA. 1993;269(20):2642-2646.

18.

Jha

Staiger

Lucas

Chandra

. Do race-specific models explain disparities in treatments after acute myocardial infarction? Am Heart J. 2007;153(5):785-791. doi:10.1016/j.ahj.2007.02.014

19.

Jha

Orav

Epstein

. Concentration and quality of hospitals that care for elderly black patients. Arch Intern Med. 2007;167(11):1177-1182. doi:10.1001/archinte.167.11.1177

20.

Ayanian

Weissman

Chasan-Taber

Epstein

. Quality of care by race and gender for congestive heart failure and pneumonia. Med Care. 1999;37(12):1260-1269. doi:10.1097/00005650-199912000-00009

21.

Cole

Nguyen

Meirkhanov

, et al. association of care at minority-serving vs non-minority-serving hospitals with use of palliative care among racial/ethnic minorities with Metastatic Cancer in the United States. JAMA Netw Open. 2019;2(2):e187633. doi:10.1001/jamanetworkopen.2018.7633

22.

Joynt

Harris

Orav

Jha

. Quality of care and patient outcomes in critical access rural hospitals. JAMA. 2011;306(1):45-52. doi:10.1001/jama.2011.902

23.

Schoenfeld

Sturgeon

Dimick

, et al. disparities in rates of surgical intervention among racial and ethnic minorities in medicare accountable care organizations. Ann Surg. 2019;269(3):459-464. doi:10.1097/SLA.0000000000002695

24.

Mehtsun

Figueroa

Zheng

Orav

Jha

. racial disparities in surgical mortality: the gap appears to have narrowed. Health Aff (Millwood). 2017;36(6):1057-1064. doi:10.1377/hlthaff.2017.0061

25.

Warner

. The unequal toll of toxic stress. Washington DC: Center for American Progress. https://www.americanprogress.org/issues/women/reports/2017/11/17/443028/unequal-toll-toxic-stress/. Accessed February 3, 2021.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.18 MB

0.20 MB

Minority-Serving Hospitals Are Associated With Low Within-Hospital Disparity

Abstract

Background

Methods

Results

Discussion

Keywords

Get full access to this article

References

Supplementary Material