J Racial Ethn Health Disparities. 2025 May 6. doi: 10.1007/s40615-025-02464-z. Online ahead of print.
ABSTRACT
BACKGROUND: In the US, there is substantial variability in low-risk cesarean birth rate by hospitals and race/ethnicity. The contribution of inequitable hospital quality to disparities in low-risk cesarean births is uncertain. We examine the contribution of birth hospital to racial/ethnic disparities in low-risk cesarean births.
METHODS: We used vital records linked with maternal birth hospitalization data (California, 2007-18). We examined self-reported race/ethnicity and low-risk cesarean birth, i.e., nulliparous, term, singleton, and vertex (NTSV) births. Poisson regression models with a mixed effect for hospital and bootstrapped errors were used to compare racial/ethnic differences in cesarean prevalence, adjusted for maternal and hospital characteristics. We used G-computation to assess how the prevalence of cesarean section by racial/ethnic group would change if all births occurred at the same distribution of hospitals as births to White individuals.
RESULTS: Among 1,594,277 NTSV births at 212 hospitals, 26.9% were cesarean. After adjustment for hospital characteristics, risk ratios for cesarean birth ranged from 1.05 for foreign-born Hispanic (95% CI 1.02-1.09) to 1.28 for Black (95% CI 1.22-1.33) individuals, relative to White individuals. In the G-computation substitution, cesarean prevalence among NTSV births was reduced for some race/ethnicities and increased for others, ranging from 87 excess events (0.3% increase) in Black populations to 6473 avoided events (5.6% decrease) among US-born Hispanic populations.
CONCLUSIONS: Racial/ethnic disparities in cesarean prevalence among low-risk births in California are not explained by individual-level maternal or hospital characteristics.
PMID:40327292 | DOI:10.1007/s40615-025-02464-z
