Beneath the Incision: Variation in Low-Risk Cesareans Among Asian and Pacific Islander Subgroups in the United States.

IF 2.8 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Louise Marie Roth, Jennifer Hyunkyung Lee, Theresa M Morris
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引用次数: 0

Abstract

Background: Quality initiatives aim to reduce primary cesarean rates in pregnancies with low clinical risk. These cesarean rates vary significantly by race-ethnicity in the United States. This study analyzes differences in low-risk primary cesareans between Asian/Pacific Islander (API) individuals and other pan-ethnic groups and among API subgroups in the United States.

Methods: We used data on all recorded births in the United States from 2010 to 2020 to analyze primary cesareans in the lowest risk NTSV (nulliparous, term, singleton, vertex) and MTSV (multiparous, term, singleton, vertex) pregnancies by race-ethnicity. We used logistic regression to compare API births with births among other pan-ethnic groups (N = 22,212,076) and to analyze variation across API subgroups (N = 1,663,167).

Results: API births had lower risk-adjusted odds of a primary cesarean than most other pan-ethnic groups. Among API subgroups, Indian and some Pacific Islander groups had higher adjusted odds of a primary cesarean, whereas Chinese, Korean, Filipino, and, especially, Japanese groups had lower odds. Foreign-born API birthing people had higher odds than U.S.-born API birthing people (NTSV odds ratio [OR] = 1.17, 95% confidence interval [CI] [1.16, 1.19], and MTSV OR = 1.11, 95% CI [1.10, 1.13]).

Conclusions: Although odds of a low-risk primary cesarean were slightly lower in API births than in births among most other pan-ethnic groups, this concealed significant variation among API subgroups and between foreign-born and U.S.-born API birthing people. These disparities suggest inequities in access to quality care and possible discrimination against some API groups, leading to unnecessary overtreatment. Efforts to reduce disparities should recognize differences across subgroups and potential barriers to culturally appropriate care.

切口下:美国亚洲和太平洋岛民亚群中低风险剖宫产的差异。
背景:质量倡议旨在降低低临床风险妊娠的原发性剖宫产率。在美国,这些剖宫产率因种族而有很大差异。本研究分析了美国亚裔/太平洋岛民(API)个体与其他泛种族群体以及API亚群之间低风险原发性剖宫产的差异。方法:我们使用2010年至2020年美国所有记录的分娩数据,按种族分析最低风险NTSV(无产、足月、单胎、顶点)和MTSV(多产、足月、单胎、顶点)妊娠的初次剖宫产。我们使用逻辑回归比较API出生与其他泛民族的出生(N = 22,212,076),并分析API亚组之间的差异(N = 1,663,167)。结果:与大多数其他泛民族相比,API出生的原发性剖宫产的风险调整几率较低。在API亚群中,印度人和一些太平洋岛民群体原发性剖宫产的调整后几率较高,而中国人、韩国人、菲律宾人,尤其是日本人的调整后几率较低。在国外出生的API出生的人比在美国出生的API出生的人有更高的几率(NTSV比值比[OR] = 1.17, 95%可信区间[CI] [1.16, 1.19], MTSV比值比= 1.11,95% CI[1.10, 1.13])。结论:尽管API出生的低风险原发性剖宫产的几率略低于大多数其他泛种族群体,但这掩盖了API亚组之间以及外国出生和美国出生的API出生人群之间的显著差异。这些差异表明,在获得高质量护理方面存在不平等,可能存在对一些API群体的歧视,从而导致不必要的过度治疗。减少差异的努力应认识到亚群体之间的差异以及文化上适当的护理的潜在障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.50
自引率
6.20%
发文量
97
审稿时长
32 days
期刊介绍: Women"s Health Issues (WHI) is a peer-reviewed, bimonthly, multidisciplinary journal that publishes research and review manuscripts related to women"s health care and policy. As the official journal of the Jacobs Institute of Women"s Health, it is dedicated to improving the health and health care of all women throughout the lifespan and in diverse communities. The journal seeks to inform health services researchers, health care and public health professionals, social scientists, policymakers, and others concerned with women"s health.
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