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Neighborhood Income and Cesarean Section Rates at a Tertiary Care Center in Canada.

Authors
  • Hodge, Meryl C1
  • Shen, Minxue2
  • Xie, Ri-Hua3
  • Wen, Shi-Wu2
  • Walker, Mark1, 2, 4
  • Wise, Michelle R5
  • Chen, Innie1, 2, 4
  • 1 Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. , (Canada)
  • 2 The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. , (Canada)
  • 3 Nanhai Hospital of Southern Medical University, Foshan Shi, China. , (China)
  • 4 Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada. , (Canada)
  • 5 Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand. , (New Zealand)
Type
Published Article
Journal
Journal of women's health (2002)
Publication Date
Dec 01, 2019
Volume
28
Issue
12
Pages
1721–1726
Identifiers
DOI: 10.1089/jwh.2018.6971
PMID: 30730242
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Background: With rising rates of cesarean sections (CSs) in Canada and worldwide, nonclinical factors for CS warrant consideration. Objective: To determine the association between a primigravid woman's neighborhood income and rates of CSs. Materials and Methods: A retrospective cohort study was conducted at an Ontario tertiary care center from January 2003 to December 2013. Rates of CSs were determined using data collected from the Discharge Abstract Database. Women with singleton live births were included. The main exposure variable was the neighborhood income quintile. A multivariable model was used to adjust for covariates and provide an estimate of the independent effect of neighborhood income on the CS rate. Results: The study cohort comprised 32,714 women. Compared with the lowest quintile, women in the highest quintile had increased rates of CSs (relative risk, RR 1.06, 95% confidence interval, CI [1.02-1.11]). Following adjustment for important confounders, there was no longer an association between the neighborhood income and CS rate (adjusted RR 1.00, 95% CI [0.99-1.01]). Women in the highest quintile were more likely to have greater maternal age (p < 0.01). Conclusions: Although differences in CS rates are seen by the neighborhood income quintile, they appear to be mediated through a combination of maternal age and other clinical factors. Neighborhood income does not appear to be an independent predictor of CS.

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