(SDAS) The Causes and consequences of disparities by race/ethnicity in Cesarean section rates

Project Number: R40 MC 08720-01
Project Date: 9/1/2007
Grantee: Boston University
Department/Center: School of Public Health/Maternal and Child Health

Final Report

Pending

Principal Investigator

Eugene Declercq PhD,
Professor and Assistant Dean for Doctoral Education, Boston University School of Public Health/Maternal and Child Health,
715 Albany Street, T5W
Boston, MA 02118-2526
declercq@bu.edu

Abstract

Principal Problem: The purpose of this research is to examine racial/ethnic disparities in the record number of primary and repeat cesarean births in the U.S. The nature of these disparities shifted in the 1990s with black non-Hispanic mothers going from a cesarean rate 1.4 percentage points below that for white non-Hispanic mothers in 1989 having a rate 2.1 percentage points higher in 2005. Given the substantial race/ethnicity disparities that already exist in maternal and infant health outcomes, this study will first analyze the causes of disparities in cesarean section rates and then examine whether or not the differences in cesarean rates increase or decrease existing disparities in health outcomes. Research Design and Methods: The study group will be limited to Massachusetts residents who gave birth in a MA hospital between 1998 and 2005 (approximately 623,000 births). The analysis is based on the Pregnancy to Early Life Longitudinal (PELL) Data System, a public-private partnership between the Boston University School of Public Health (BUSPH), the Massachusetts Department of Public Health, and the CDC, the primary funding agency. The core of PELL consists of the annual linkage of all Massachusetts birth (BC) and fetal death (FD) certificate records with the birth-related hospital discharge (HD) records of both mother and infant (for live births). We are proposing four study questions: Question 1 Bases of Disparities. This study will determine if the differences in cesarean rates by race/ethnicity are explained by medical, demographic, behavioral and institutional factors. Our outcome will be method of delivery and results will be examined by race/ethnicity (as the primary independent variable) controlling for an array of medical risk factors, labor and delivery complications, contextual variables as well as demographic, behavioral and institutional factors. Question 2 Maternal Morbidity. It is well known that maternal health outcomes vary by race/ethnicity. Our question is whether or not method of delivery mitigates or exacerbates that relationship controlling for the demographic, institutional, etc. factors described above. The primary outcome measure for maternal health will be rates and indications for rehospitalization, observational stays and emergency room visits in the first six months after birth, divided into two periods: 1-28 days; 29-180 days. Question 3 Infant Morbidity. Differential infant outcomes by race/ethnicity have been widely studied, but our question again concerns the added benefit or risks associated with method of delivery, using an already developed measure of neonatal morbidity which will be adjusted by inclusion of data on NICU admissions as well as longer term (up to 6 months) rehospitalization. Question 4 Hospital Costs. The examination of hospital costs will be based on the charges data available in the hospital discharge dataset. The total charges for mothers and infants will be calculated and then adjusted by cost to charge ratios and in turn adjusted for inflation. Relationship to MCHB Strategic Research Issues: This research is particularly related to Strategic Issues II (elimination of health disparities) and III (assurance of quality of care).

Publications

Pending

Keywords

Health Disparities; Cesarean Section; Maternal Morbidity; Infant Mortality and Morbidity; Cost Analysis; Access to Health Care; Multiple Cesarean Birth; Linked Dataset