Cassie L. Odahowski , Peiyin Hung , Berry A. Campbell , Jihong Liu , Nansi S. Boghossian , Anirban Chatterjee , Yiwen Shih , Chelsea Norregaard , Bo Cai , Xiaoming Li
{"title":"南卡罗来纳州 COVID-19 大流行之前和期间剖宫产率的城乡和种族差异。","authors":"Cassie L. Odahowski , Peiyin Hung , Berry A. Campbell , Jihong Liu , Nansi S. Boghossian , Anirban Chatterjee , Yiwen Shih , Chelsea Norregaard , Bo Cai , Xiaoming Li","doi":"10.1016/j.midw.2024.104075","DOIUrl":null,"url":null,"abstract":"<div><h3>Problem</h3><p>Unnecessary cesarean delivery increases the risk of complications for birthing people and infants.</p></div><div><h3>Background</h3><p>Examining the intersectionality of rural and racial disparities in low-risk cesarean delivery is necessary to improve equity in quality obstetrics care.</p></div><div><h3>Aim</h3><p>To evaluate rural and racial/ethnic differences in Nulliparous, Term, Singleton, Vertex (NTSV) and primary cesarean delivery rates before and during the COVID-19 pandemic in South Carolina.</p></div><div><h3>Methods</h3><p>This retrospective cohort study used birth certificates linked to all-payer hospital discharge data for South Carolina childbirths from 2018 to 2021. Multilevel logistic regressions examined differences in cesarean outcomes by rural/urban hospital location and race/ethnicity of birthing people during pre-pandemic (January 2018–February 2020) and peri-pandemic periods (March 2020–December 2021), adjusting for maternal, infant, and hospital characteristics among two low-risk pregnancy cohorts: 1) Nulliparous, Term, Singleton, Vertex (NTSV, <em>n</em> = 65,974) and 2) those without prior cesarean (primary, <em>n</em> = 167,928).</p></div><div><h3>Findings</h3><p>Black vs. White disparities remained for NTSV cesarean in adjusted models (urban pre-pandemic aOR = 1.34, 95 %CI 1.23–1.46) but were not significantly different for primary cesarean, apart from rural settings peri-pandemic (aOR = 0.87, 95 %CI 0.79–0.96). Hispanic individuals had higher adjusted odds of NTSV cesarean only for rural settings pre-pandemic (aOR = 1.28, 95 %CI 1.05–1.56), but this disparity was not significant during the pandemic (aOR = 1.13, 95 %CI 0.93–1.37).</p></div><div><h3>Discussion and conclusion</h3><p>Observed rural and racial/ethnic disparities in cesarean delivery outcomes were present before and during the COVID-19 pandemic. Strategies effective in reducing racial disparities in primary cesarean may be useful in also reducing Black vs. White NTSV cesarean disparities.</p></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":null,"pages":null},"PeriodicalIF":2.6000,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Rural-urban and racial differences in cesarean deliveries before and during the COVID-19 pandemic in South Carolina\",\"authors\":\"Cassie L. Odahowski , Peiyin Hung , Berry A. Campbell , Jihong Liu , Nansi S. Boghossian , Anirban Chatterjee , Yiwen Shih , Chelsea Norregaard , Bo Cai , Xiaoming Li\",\"doi\":\"10.1016/j.midw.2024.104075\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Problem</h3><p>Unnecessary cesarean delivery increases the risk of complications for birthing people and infants.</p></div><div><h3>Background</h3><p>Examining the intersectionality of rural and racial disparities in low-risk cesarean delivery is necessary to improve equity in quality obstetrics care.</p></div><div><h3>Aim</h3><p>To evaluate rural and racial/ethnic differences in Nulliparous, Term, Singleton, Vertex (NTSV) and primary cesarean delivery rates before and during the COVID-19 pandemic in South Carolina.</p></div><div><h3>Methods</h3><p>This retrospective cohort study used birth certificates linked to all-payer hospital discharge data for South Carolina childbirths from 2018 to 2021. Multilevel logistic regressions examined differences in cesarean outcomes by rural/urban hospital location and race/ethnicity of birthing people during pre-pandemic (January 2018–February 2020) and peri-pandemic periods (March 2020–December 2021), adjusting for maternal, infant, and hospital characteristics among two low-risk pregnancy cohorts: 1) Nulliparous, Term, Singleton, Vertex (NTSV, <em>n</em> = 65,974) and 2) those without prior cesarean (primary, <em>n</em> = 167,928).</p></div><div><h3>Findings</h3><p>Black vs. White disparities remained for NTSV cesarean in adjusted models (urban pre-pandemic aOR = 1.34, 95 %CI 1.23–1.46) but were not significantly different for primary cesarean, apart from rural settings peri-pandemic (aOR = 0.87, 95 %CI 0.79–0.96). Hispanic individuals had higher adjusted odds of NTSV cesarean only for rural settings pre-pandemic (aOR = 1.28, 95 %CI 1.05–1.56), but this disparity was not significant during the pandemic (aOR = 1.13, 95 %CI 0.93–1.37).</p></div><div><h3>Discussion and conclusion</h3><p>Observed rural and racial/ethnic disparities in cesarean delivery outcomes were present before and during the COVID-19 pandemic. Strategies effective in reducing racial disparities in primary cesarean may be useful in also reducing Black vs. White NTSV cesarean disparities.</p></div>\",\"PeriodicalId\":18495,\"journal\":{\"name\":\"Midwifery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-06-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Midwifery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S026661382400158X\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Midwifery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S026661382400158X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
Rural-urban and racial differences in cesarean deliveries before and during the COVID-19 pandemic in South Carolina
Problem
Unnecessary cesarean delivery increases the risk of complications for birthing people and infants.
Background
Examining the intersectionality of rural and racial disparities in low-risk cesarean delivery is necessary to improve equity in quality obstetrics care.
Aim
To evaluate rural and racial/ethnic differences in Nulliparous, Term, Singleton, Vertex (NTSV) and primary cesarean delivery rates before and during the COVID-19 pandemic in South Carolina.
Methods
This retrospective cohort study used birth certificates linked to all-payer hospital discharge data for South Carolina childbirths from 2018 to 2021. Multilevel logistic regressions examined differences in cesarean outcomes by rural/urban hospital location and race/ethnicity of birthing people during pre-pandemic (January 2018–February 2020) and peri-pandemic periods (March 2020–December 2021), adjusting for maternal, infant, and hospital characteristics among two low-risk pregnancy cohorts: 1) Nulliparous, Term, Singleton, Vertex (NTSV, n = 65,974) and 2) those without prior cesarean (primary, n = 167,928).
Findings
Black vs. White disparities remained for NTSV cesarean in adjusted models (urban pre-pandemic aOR = 1.34, 95 %CI 1.23–1.46) but were not significantly different for primary cesarean, apart from rural settings peri-pandemic (aOR = 0.87, 95 %CI 0.79–0.96). Hispanic individuals had higher adjusted odds of NTSV cesarean only for rural settings pre-pandemic (aOR = 1.28, 95 %CI 1.05–1.56), but this disparity was not significant during the pandemic (aOR = 1.13, 95 %CI 0.93–1.37).
Discussion and conclusion
Observed rural and racial/ethnic disparities in cesarean delivery outcomes were present before and during the COVID-19 pandemic. Strategies effective in reducing racial disparities in primary cesarean may be useful in also reducing Black vs. White NTSV cesarean disparities.