Spatial and Racial/Ethnic Variation in the Prevalence of Cesarean Delivery in a South Carolina Medical Center.

IF 3.2 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Journal of Racial and Ethnic Health Disparities Pub Date : 2024-10-18 DOI:10.1007/s40615-024-02218-3

Jeffrey T Howard, Sam Lawton, Dulaney Wilson, Amartha Gore, Latha Hebbar, Christine Morton, Christopher Goodier, Myrtede Alfred

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引用次数: 0

Abstract

Introduction: While racial/ethnic disparities in cesarean delivery have been noted in the literature, less is known about the intersection between individual-level race/ethnicity and community-level social vulnerability as factors in cesarean delivery. The goal was to use medical record data from a large medical center combined with census tract-level data to examine patterns of social vulnerability, racial population distribution, and prevalence of cesarean delivery.

Methods: Data were obtained from electronic medical records of patients from a large medical center in South Carolina from 2019 to 2020. The outcome variable was cesarean delivery (yes/no), and covariates included the year of delivery; age of patient; race/ethnicity; spoken language; BMI categories; clinical indications of anemia, hypertension, preeclampsia, and diabetes; and census tract Social Vulnerability Index (SVI). Generalized linear mixed models for multilevel binary logistic regression were used to test the main hypothesis that the census tract level Social Vulnerability Index is positively associated with cesarean delivery.

Results: Among a total of 5011 patients, we found that non-Hispanic Black mothers were more likely to have cesarean deliveries compared with non-Hispanic White mothers. After controlling for census tract-level SVI, the individual-level race/ethnicity association was no longer significant. Significant spatial autocorrelation across census tracts was evident for cesarean delivery prevalence, non-Hispanic Black population, and SVI. A high prevalence of cesarean delivery tended to cluster with high SVI and a high non-Hispanic Black population.

Conclusions: We found that non-Hispanic Black mothers were more likely to have cesarean deliveries, which was explained by census tract differences in the SVI.

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南卡罗来纳州一家医疗中心剖腹产率的空间和种族/族裔差异。

导言：虽然剖腹产中的种族/民族差异已在文献中有所提及，但人们对个人层面的种族/民族与社区层面的社会脆弱性之间的交集作为剖腹产的影响因素却知之甚少。我们的目标是利用一家大型医疗中心的医疗记录数据与人口普查区数据相结合，研究社会脆弱性、种族人口分布和剖宫产发生率的模式：数据来自南卡罗来纳州一家大型医疗中心 2019 年至 2020 年期间的患者电子病历。结果变量为剖宫产（是/否），协变量包括分娩年份、患者年龄、种族/民族、口语、体重指数类别、贫血、高血压、子痫前期和糖尿病等临床指征以及人口普查区社会弱势指数（SVI）。研究采用多层次二元逻辑回归的广义线性混合模型来检验主要假设，即人口普查区一级的社会弱势指数与剖宫产呈正相关：在总共 5011 名患者中，我们发现与非西班牙裔白人母亲相比，非西班牙裔黑人母亲更有可能进行剖宫产。在控制了人口普查区层面的 SVI 后，个人层面的种族/族裔关联不再显著。剖宫产率、非西班牙裔黑人人口和 SVI 在不同人口普查区之间存在明显的空间自相关性。高剖腹产率往往与高 SVI 和高非西班牙裔黑人人口聚集在一起：我们发现，非西班牙裔黑人母亲更有可能进行剖宫产，这可以通过人口普查区的 SVI 差异来解释。

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来源期刊

Journal of Racial and Ethnic Health Disparities PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

7.30

自引率

5.10%

发文量

263

期刊介绍： Journal of Racial and Ethnic Health Disparities reports on the scholarly progress of work to understand, address, and ultimately eliminate health disparities based on race and ethnicity. Efforts to explore underlying causes of health disparities and to describe interventions that have been undertaken to address racial and ethnic health disparities are featured. Promising studies that are ongoing or studies that have longer term data are welcome, as are studies that serve as lessons for best practices in eliminating health disparities. Original research, systematic reviews, and commentaries presenting the state-of-the-art thinking on problems centered on health disparities will be considered for publication. We particularly encourage review articles that generate innovative and testable ideas, and constructive discussions and/or critiques of health disparities.Because the Journal of Racial and Ethnic Health Disparities receives a large number of submissions, about 30% of submissions to the Journal are sent out for full peer review.