目的:不必要的剖宫产会增加分娩者和婴儿并发症的风险。
背景:检查低风险剖宫产中农村和种族差异的交叉性对于提高优质产科护理的公平性是必要的。
目的:评估未生育的农村和种族/民族差异,Term,辛格尔顿,南卡罗来纳州COVID-19大流行之前和期间的顶点(NTSV)和初次剖宫产率。
方法:这项回顾性队列研究使用了2018年至2021年南卡罗来纳州分娩的所有付款人出院数据相关的出生证明。多水平逻辑回归分析了在大流行前(2018年1月至2020年2月)和大流行期间(2020年3月至2021年12月),按农村/城市医院地点和分娩者的种族/种族划分的剖宫产结果差异。适应母体,婴儿,和两个低风险妊娠队列中的医院特征:1)未产,Term,辛格尔顿,顶点(NTSV,n=65,974)和2)那些没有剖宫产的人(原发性,n=167,928)。
结果:Blackvs.在调整后的模型中,NTSV剖宫产仍然存在白色差异(城市大流行前aOR=1.34,95CI1.23-1.46),但初次剖宫产没有显着差异。除农村地区外,大流行期间(aOR=0.87,95CI0.79-0.96)。仅在大流行前的农村地区,西班牙裔个体NTSV剖宫产的校正几率较高(aOR=1.28,95CI1.05-1.56),但这种差异在大流行期间并不显著(aOR=1.13,95CI0.93-1.37).
结论:在COVID-19大流行之前和期间,观察到农村和种族/族裔在剖宫产结局方面存在差异。有效减少初次剖宫产中种族差异的策略可能有助于减少Blackvs.白色NTSV剖宫产差异。
OBJECTIVE: Unnecessary cesarean delivery increases the risk of complications for birthing people and infants.
BACKGROUND: Examining the intersectionality of rural and racial disparities in low-risk cesarean delivery is necessary to improve equity in quality obstetrics care.
OBJECTIVE: To evaluate rural and racial/ethnic differences in Nulliparous, Term, Singleton, Vertex (NTSV) and primary cesarean delivery rates before and during the COVID-19 pandemic in South Carolina.
METHODS: This retrospective cohort study used birth certificates linked to all-payer hospital discharge data for South Carolina childbirths from 2018 to 2021. Multilevel logistic regressions examined differences in cesarean outcomes by rural/urban hospital location and race/ethnicity of birthing people during pre-pandemic (January 2018-February 2020) and peri-pandemic periods (March 2020-December 2021), adjusting for maternal, infant, and hospital characteristics among two low-risk pregnancy cohorts: 1) Nulliparous, Term, Singleton, Vertex (NTSV, n = 65,974) and 2) those without prior cesarean (primary, n = 167,928).
RESULTS: Black vs. White disparities remained for NTSV cesarean in adjusted models (urban pre-pandemic aOR = 1.34, 95 %CI 1.23-1.46) but were not significantly different for primary cesarean, apart from rural settings peri-pandemic (aOR = 0.87, 95 %CI 0.79-0.96). Hispanic individuals had higher adjusted odds of NTSV cesarean only for rural settings pre-pandemic (aOR = 1.28, 95 %CI 1.05-1.56), but this disparity was not significant during the pandemic (aOR = 1.13, 95 %CI 0.93-1.37).
CONCLUSIONS: Observed rural and racial/ethnic disparities in cesarean delivery outcomes were present before and during the COVID-19 pandemic. Strategies effective in reducing racial disparities in primary cesarean may be useful in also reducing Black vs. White NTSV cesarean disparities.