Influence of Race/Ethnicity on Cesarean Delivery by Year in the United States

Objective: Attempts have been made to reduce the rate of cesarean delivery in the United States. The intent of this study was to examine the trends of cesarean delivery rates over time by race/ethnicity in the United States, stratified by parity and history of prior cesarean delivery. Methods: A retrospective cohort study in the United States between 2011 and 2018 using linked vital statistics data derived from National Center for Health Statistics. Race/ethnicity was categorized into non-Hispanic white, non-Hispanic Black, Hispanic, Asian, and American Indian & Alaska Native (AIAN). Chi-square tests were used to compare rates of cesarean delivery between years among all racial/ethnic groups. Multivariable logistic regression analyses were used to examine the association of race/ethnicity with cesarean delivery, controlling for maternal age, BMI, parity, education, number of prenatal visits, insurance, diabetic disease and hypertensive disease. Our main outcomes were rates of cesarean delivery in each considered racial/ethnic group and year by parity and history of prior cesarean delivery. Results: Our cohort of 27,779,284 patients consisted of 14,982,866 (53.9%) white, 4,046,238 (14.6%) Black, 6,750,058 (24.3%) Hispanic, 1,773,798 (6.4%) Asian, and 226,324 (0.8%) AIAN individuals. When examining nulliparous parturients, the rates of cesarean delivery decreased for white, Asian, and AIAN nulliparas, but increased from 33.1% to 33.5% (p=0.01) for Black nulliparas between the years of 2011 to 2018. The rates of cesarean delivery in multiparous individuals decreased across all racial/ethnic groups. Conclusion: Rates of cesarean delivery increased in Black individuals but decreased in all other races/ethnicities over time among nulliparas. During a time when efforts were made to reduce the risk of cesarean delivery, rates both increased in Black individuals and health disparities increased. As these associations persisted even when controlling for confounders in multivariate analysis, investigation of structural contributors of these varied outcomes is needed. Funding: None to declare. Declaration of Interest: None to declare.
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