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