Racial/ethnic differences in the likelihood of cesarean delivery, California

• Published in: American journal of public health (1971) 1995-05, Vol.85 (5), p.625-630
• Main Authors: Braveman, P, Egerter, S, Edmonston, F, Verdon, M
• Format: Article
• Language: English
• Subjects: Adult; African Americans - statistics & numerical data; Age; Asian Americans; Bioethics; Biological and medical sciences; Birth certificates; Birth Weight; Births; Caesarean section; California; Censuses; Cesarean section; Cesarean Section - statistics & numerical data; Continental Population Groups; Decision making; Delivery. Postpartum. Lactation; Education; Ethnic Groups - statistics & numerical data; Female; Gynecology. Andrology. Obstetrics; Hispanic Americans; Hospitals, County; Hospitals, Proprietary; Hospitals, Voluntary; Humans; Infant, Newborn; Insurance coverage; Likelihood; Marital status; Medicaid; Medical sciences; Minority & ethnic groups; Multiple births; Obstetrical techniques; Parent educational background; Postal codes; Poverty; Pregnancy; Pregnant Women; Prenatal care; Public health; Racial differences; Retrospective Studies; Risk Factors; Sociodemographics; Socioeconomic Factors; Teaching hospitals; White people; Women; Womens health
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.85.5.625

The purpose of this study was to determine whether women's sociodemographic characteristics are independently associated with cesarean delivery. A retrospective review was conducted of hospital discharge data for singleton first births in California in 1991. After insurance and personal, community, medical, and hospital characteristics had been controlled, Blacks were 24% more likely to undergo cesarean delivery than Whites; only among low-birthweight and county hospital births were Blacks not at a significantly elevated risk. Among women who resided in substantially non-English-speaking communities, who delivered high-birthweight babies, or who gave birth at for-profit hospitals, cesarean delivery appeared to be more likely among non-Whites and was over 40% more likely among Blacks than among Whites. The findings cannot establish causation, but the significant racial/ethnic disparities in delivery mode, despite adjustment for social, economic, medical, and hospital factors, suggest inappropriate influences on clinical decision making that would not be addressed by changes in reimbursement. If practice variations among providers are involved, de facto racial differences in access to optimal care may be indicated. The role of provider and patient attitudes and expectations in the observed racial/ethnic differentials should also be explored.