142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

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Location, location, location: The role of geography in cesarean delivery rates in the US

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 1:10 PM - 1:30 PM

Wade Bannister, PhD , Optum, Orange, CA
Melissa Lo, MS , OptumHealth Product Analytics, Optum, Golden Valley, MN
The high rate of cesarean section deliveries in the United States is a pressing public health issue as cesarean deliveries in healthy mothers unnecessarily increase the risk of adverse outcomes for both mother and newborn.   Current literature acknowledges the existence of geographic distinctions in cesarean rates, but this phenomenon is not well understood beyond the notion of differing physician practice styles.  This study examines how geography - particularly relating to the availability of healthcare resources – may impact cesarean rates.

Using a commercially insured US population, we obtained administrative data on nearly one million deliveries between 2008 and 2013.  We identified counties with unusually high (over 43%) or low (below 28%) cesarean delivery rates.  Matched cohorts were created from each group using propensity score matching to control for maternal age, multiple gestation, and maternal risk factors.  Using these matched cohorts, we then compared socioeconomic and healthcare supply characteristics between the areas using chi squared tests.

Comparing geographic characteristics of each area, statistically significant associations were found between higher cesarean rates and higher concentrations of Obstetrician-Gynecologist physicians per female resident and hospital beds per resident.  There were also statistically significant associations between elevated cesarean rates and high household income levels, low concentrations of non-white residents, and lower average educational attainment.

These findings suggest that higher availability of Obstetrician-Gynecologist physicians and hospital beds in a region may play a significant role in higher rates of cesarean deliveries.  This relationship may help explain geographic variation in cesarean rates outside of maternal characteristics.

Learning Areas:

Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Identify geography-related healthcare supply factors that are associated with higher rates of caesarean deliveries.

Keyword(s): Maternal and Child Health, Outcomes Research

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-investigator on numerous federally and state funded research grants in Health Outcomes and Disparities research. I currently lead a team of researchers focused on maternal and child health program evaluations.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
UnitedHealth Group Optum Healthcare Analytics Employment (includes retainer)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.