Intrinsic racial differences in the risk of cesarean delivery are not explained by differences in caregivers or hospital site of delivery

Chung, Judith H.; Garite, Thomas J.; Kirk, Adele M.; Hollard, Amie L.; Wing, Deborah A.; Lagrew, David C.

doi:10.1016/j.ajog.2005.11.043

« Previous Next »American Journal of Obstetrics & Gynecology
Volume 194, Issue 5 , Pages 1323-1328, May 2006

Intrinsic racial differences in the risk of cesarean delivery are not explained by differences in caregivers or hospital site of delivery

Judith H. Chung, MD
- Department of Obstetrics and Gynecology, Women's Hospital, Long Beach Memorial Medical Center, Long Beach, CA
- Division of Maternal-Fetal Medicine, University of California, Irvine, Orange, CA
- Reprint requests: Judith H. Chung, MD, Long Beach Memorial Medical Center Women's Hospital, 2801 Atlantic Ave, Long Beach, CA 90806.
Thomas J. Garite, MD
- Division of Maternal-Fetal Medicine, University of California, Irvine, Orange, CA
Adele M. Kirk, MHA
- Department of Health Services, University of California, Los Angeles, School of Public Health, Los Angeles, CA
Amie L. Hollard, MD
- Division of Maternal-Fetal Medicine, University of California, Irvine, Orange, CA
- Department of Maternal-Fetal Medicine, Saint Elizabeth Regional Medical Center, Lincoln, NE
Deborah A. Wing, MD
- Division of Maternal-Fetal Medicine, University of California, Irvine, Orange, CA
David C. Lagrew, MD
- Division of Maternal-Fetal Medicine, University of California, Irvine, Orange, CA
- Saddleback Memorial Medical Center, Laguna Hills, CA

Received 22 June 2005; received in revised form 3 November 2005; accepted 28 November 2005. published online 24 April 2006.

Objective

This study was undertaken to assess whether racial differences in the risk of cesarean delivery result from differing practices of their caregivers or the hospitals at which they deliver.

Study design

A retrospective cohort study was performed using the Perinatal Database of the Memorial Health Care System. Logistic regression was used to estimate the risk of primary cesarean delivery among patients eligible for labor. The contribution of hospital and physician level cluster correlation was evaluated using fixed and random effects regression models.

Results

Compared with white patients, black and Hispanic patients were 75% and 22% more likely to undergo primary cesarean delivery. Further adjustment for hospital and physician level cluster correlation resulted in persistently increased risks of primary cesarean delivery in black (54%) and Hispanic patients (12%).