Disparities in Cesarean Delivery Rates and Associated Adverse Neonatal Outcomes in New York City Hospitals
- 1 June 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Obstetrics & Gynecology
- Vol. 113 (6), 1239-1247
- https://doi.org/10.1097/aog.0b013e3181a4c3e5
Abstract
OBJECTIVE: To examine the primary cesarean delivery rates and associated neonatal outcomes by insurance status in public and private hospitals in New York City. METHODS: We accessed Vital statistics data on all births to women with Medicaid or private insurance from 1996 through 2003, compiling a total of 321,308 nulliparous women who delivered singleton neonates by either normal spontaneous vaginal delivery or primary cesarean delivery. Rates of primary cesarean delivery and adverse neonatal outcomes were examined by hospital type and insurance status while controlling for potential confounders. RESULTS: There were 51,682 and 269,626 women who delivered in public hospitals and private hospitals, respectively. The cesarean delivery rate of women with private insurance delivering in private hospitals was 30.4% compared with a cesarean rate of 21.2% in Medicaid patients delivering in public hospitals (adjusted odds ratio [OR] 1.57, 95% confidence interval [CI] 1.53–1.63). The percent of infants born to women with private insurance and Medicaid delivering in private hospitals with a 5-minute Apgar score less than 7 was 0.6% and 0.8% compared with 1.0% of infants delivering in the public hospital system (adjusted OR 0.59, 95% CI 0.51– 0.68 and adjusted OR 0.73, 95% CI 0.65– 0.82). The neonatal intensive care unit admission rate was also lower in neonates born in private hospitals at 6.7% and 8.5% compared with a 12.8% admission rate in public hospitals (adjusted OR 0.48, 95% CI 0.46–0.51 and adjusted OR 0.59, 95% CI 0.57– 0.62 after controlling for mode of delivery). CONCLUSION: Even when controlling for confounders, there was an association between primary cesarean delivery and insurance status regardless of hospital type. There was also a higher risk of adverse neonatal outcomes in the public hospitals regardless of mode of delivery. LEVEL OF EVIDENCE: IIIKeywords
This publication has 28 references indexed in Scilit:
- Planned cesarean versus planned vaginal delivery at term: Comparison of newborn infant outcomesAmerican Journal of Obstetrics and Gynecology, 2006
- Maternal Obesity and Diabetes as Risk Factors for Adverse Pregnancy Outcomes: Differences Among 4 Racial/Ethnic GroupsAmerican Journal of Public Health, 2005
- Trends and Racial/Ethnic Disparities in Gestational Diabetes Among Pregnant Women in New York City, 1990–2001American Journal of Public Health, 2005
- Prepregnancy weight and adverse perinatal outcomes in an ethnically diverse populationObstetrics & Gynecology, 2003
- Cesarean deliveries for Medicaid patients: A comparison in public and private hospitals in Los Angeles CountyAmerican Journal of Obstetrics and Gynecology, 1999
- Racial/ethnic differences in the likelihood of cesarean delivery, California.American Journal of Public Health, 1995
- Trends in cesarean section use in California, 1983 to 1990American Journal of Obstetrics and Gynecology, 1993
- The Cesarean Decision in New York State, 1986Medical Care, 1992
- Socioeconomic Differences in Rates of Cesarean SectionThe New England Journal of Medicine, 1989
- Birth complication reporting: the effect of birth certificate design.American Journal of Public Health, 1984