Abstract：
Our objective was to assess the relationship of socioeconomic disadvantage and race/ethnicity with low-risk cesarean birth. We examined birth certificates (2007-18) linked with maternal hospitalization data from California; the outcome was cesarean birth among low-risk deliveries (i.e., nulliparous, term, singleton, vertex [NTSV]). We used GEE Poisson regression with an interaction term for race/ethnicity (7 groups) and a measure of socioeconomic disadvantage (census tract-level neighborhood deprivation index [NDI], education, or insurance). Among 1,815,933 NTSV births, 26.6% were cesarean. When assessing the joint effect of race/ethnicity and socioeconomic disadvantage among low-risk births, risk of cesarean birth increased with socioeconomic disadvantage for most racial/ethnic groups, and disadvantaged Black individuals had the highest risks; e.g., Black individuals with a high school education or less had a risk ratio of 1.49 (95% CI 1.45-1.53), relative to White individuals with a college degree. The disparity in risk of cesarean birth between Black and White individuals was observed across all strata of socioeconomic disadvantage. Asian American and Hispanic individuals had higher risks than White individuals at lower socioeconomic disadvantage; this disparity was not observed at higher levels of disadvantage. Black individuals have a persistent, elevated risk of cesarean birth, relative to White individuals, regardless of socioeconomic disadvantage.
摘要：
我们的目的是评估社会经济劣势和种族/民族与低风险剖宫产的关系。我们检查了与加利福尼亚州产妇住院数据相关的出生证明（2007-18）；结果是低风险分娩中的剖宫产（即未产,term,单身人士,顶点[NTSV])。我们使用GEEPoisson回归，其中包含种族/种族（7组）的相互作用项和社会经济劣势的度量（人口普查道水平的邻里剥夺指数[NDI]，教育,或保险)。在1,815,933名NTSV出生中，26.6%为剖宫产。在评估低风险分娩中种族/民族和社会经济劣势的联合影响时，对于大多数种族/族裔群体，剖宫产的风险随着社会经济劣势而增加，处境不利的黑人个人风险最高；例如，高中或以下文化程度的黑人个体的风险比为1.49（95％CI1.45-1.53），相对于拥有大学学位的白人。在社会经济劣势的所有阶层中，观察到黑人和白人之间的剖宫产风险差异。亚裔美国人和西班牙裔人的风险高于白人，处于较低的社会经济劣势；在较高的劣势水平上没有观察到这种差异。黑人个体有一种执着，剖宫产的风险升高，相对于白人，无论社会经济劣势如何。
