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Multi-level Drivers of Disparities in Hispanic Cesarean Delivery Rates in US-Mexico Border States

  • Jill A. McDonaldEmail author
  • Anup Amatya
  • Charlotte C. Gard
Article

Abstract

Background

Hispanic women living along the US-Mexico border have higher cesarean delivery rates than non-Hispanic white women, African American women, and other Hispanic women in the USA. Their rates also exceed those of other Hispanic women in states that border Mexico and non-Hispanic white women along the border. Our objective was to determine the causes of the disparities in border Hispanic cesarean rates.

Methods

Using the 2015 birth certificate file and other sources, we performed a twofold Oaxaca-Blinder decomposition analysis of the disparities in low-risk primary and repeat cesarean rates between Hispanic and non-Hispanic white women in the US-Mexico border counties and Hispanic women residing in nonborder counties of border states.

Results

Rates of low-risk primary cesarean among border Hispanic, nonborder Hispanic, and border non-Hispanic white women were 21.1%, 15.0%, and 16.5%, respectively. Higher Hispanic concentration in county of residence, a larger proportion of for-profit hospital beds, and greater poverty accounted for 24.7%, 22.1%, and 11.1% of the border-nonborder Hispanic difference, respectively. No other variable explained more than 5% of the difference. Higher Hispanic concentration, more for-profit beds, less attendance by an MD, higher BMI, and greater poverty explained 60.6%, 42.4%, 42.4%, 27.4%, and 21.3%, respectively, of the Hispanic-non-Hispanic white difference. Hispanic concentration and for-profit beds were also important explanatory variables for low-risk repeat cesareans.

Conclusion

Efforts to address potentially unnecessary cesareans among Hispanic women on the border should recognize that community demographic and health delivery system characteristics are more influential than maternal medical risk factors.

Keywords

Cesarean section Health disparities Hispanic Americans Oaxaca-Blinder Poverty 

Notes

Acknowledgments

We gratefully acknowledge the assistance of Mr. Jesus Sigala, MS, in the creation of data files and variables used in the analysis. Mr. Sigala was a graduate student in the Department of Economics, Applied Statistics, and International Business, New Mexico State University, and was compensated through the same grant as the authors.

Funding Information

This project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under the Maternal and Child Health Field Initiated Research Program, grant no. R40MC30756. HRSA had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Compliance with Ethical Standards

The Institutional Review Board at the authors’ institution approved this study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

40615_2019_652_MOESM1_ESM.pdf (511 kb)
ESM 1 (PDF 510 kb)

References

  1. 1.
    American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol. 2014;123:693–711.CrossRefGoogle Scholar
  2. 2.
    American College of Obstetricians and Gynecologists. Vaginal birth after previous cesarean delivery. Practice Bulletin 115, August 2010.Google Scholar
  3. 3.
    American Hospital Association. AHA Annual Survey Database [Internet]. Chicago: AHA; c 2018 [cited 2018 Dec 7]. Available online: https://www.ahadataviewer.com/additional-data-products/AHA-Survey
  4. 4.
    Baicker K, Buckles KS, Chandra A. Geographic variation in the appropriate use of cesarean delivery. Health Aff (Millwood). 2006;25:w355–67.CrossRefGoogle Scholar
  5. 5.
    Betran AP, Zhang J, Torloni MR, Qulmezoglu AM. Determination of a single, universal threshold for cesarean section rate is not the way forward. Evid Based Med. 2016;21(6):237.CrossRefGoogle Scholar
  6. 6.
    Braveman P, Egerter S, Edmonston F, Verdon M. Racial/ethnic differences in the likelihood of cesarean delivery, California. Am J Pub Health. 1995;85:625–30.CrossRefGoogle Scholar
  7. 7.
    Caceres IA, Arcaya M, Declercq E, et al. Hospital differences in cesarean deliveries in Massachusetts (US) 2004-2006: the case against case-mix artifact. PLoS ONE. 2013;8:e57817.CrossRefGoogle Scholar
  8. 8.
    Centers for Disease Control and Prevention. National Center for Health Statistics. National Vital Statistics System. U.S. Census populations with bridged race categories [Internet]. Atlanta: CDC; [last reviewed 2018; cited 2018 Dec 7]. Available online: https://www.cdc.gov/nchs/nvss/bridged_race.htm
  9. 9.
    Cunningham FG, Bangdiwala S, Brown SS, et al. National Institutes of Health Consensus Development Conference Statement: vaginal birth after cesarean: new insights. March 8-10, 2010. Obstet Gynecol. 2010;115:1279–95.CrossRefGoogle Scholar
  10. 10.
    Curtin SC, Gregory KD, Korst LM, SFG U. Maternal morbidity for vaginal and cesarean deliveries according to previous cesarean history. New data from the birth certificate, 2013. National vital Stats Rep. 2015:64(4).Google Scholar
  11. 11.
    Data.HRSA.gov. Data Downloads. Area Health Resources Files [Internet]. Rockville (MD): Health Resources and Services Administration; [cited 2018 Dec 7]. Available online: https://data.hrsa.gov/data/download
  12. 12.
    DeSisto CL, Hirai AH, Collins JW, Rankin KM. Deconstructing a disparity: explaining excess preterm birth among U.S.-born black women. Ann Epidemiol. 2018;28:225–30.CrossRefGoogle Scholar
  13. 13.
    Dietz P, Bombard J, Mulready-Ward C, Gauthier J, Sackoff J, Brozicevic P, et al. Validation of selected items on the 2003 U.S. Standard Certificate of Live Birth. Pub Health Rep. 2015;130:60–70.CrossRefGoogle Scholar
  14. 14.
    Guendelman S, Gemmill A, Thornton D, et al. Prevalence, disparities, and determinants of primary cesarean births among first-time mothers in Mexico. Health Aff (Millwood) 2017; Available online:  https://doi.org/10.1377/hlthaff.2016.1084.CrossRefGoogle Scholar
  15. 15.
    Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Mathews TJ. Births: final data for 2014. Table #21. Births by method of delivery and race and Hispanic origin of mother: United States,1989 -2014. Nat Vit Stats Rep 2015;64(12). Hyattsville. Available online: https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_12.pdf
  16. 16.
    Henke RM, Wier LM, Marder WD, Friedman BS, Wong HS. Geographic variation in cesarean delivery in the United States by payer. BMC Pregnancy Childbirth. 2014;14:387.  https://doi.org/10.1186/s12884-014-0387-x.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Heredia-Pi I. Servan-Mori1 EE, Wirtz VJ, Avila-Burgos L, Lozano R. Obstetric care and method of delivery in Mexico: results from the 2012 National Health and Nutrition Survey. PloS ONE. 2014;9:e104166.CrossRefGoogle Scholar
  18. 18.
    Hirai AH, Hayes DK, Taualii MM, Singh GK, Fuddy LJ. Excess infant mortality among native Hawaiians: identifying determinants for preventive action. Am J Public Health. 2013;103:e88–95.  https://doi.org/10.2105/AJPH.2013.301294).CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Hoxha I, Syrogiannouli L, Braha M, Goodman DC, da Costa BR, Jüni P. Caesarean sections and private insurance: systematic review and meta-analysis. BMJ Open. 2017;7:e016600.CrossRefGoogle Scholar
  20. 20.
    Hoxha I, Syrogiannouli L, Luta X, et al. Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis. BMJ Open. 2017;7:e013670.CrossRefGoogle Scholar
  21. 21.
    Huesch M, Doctor JN. Factors associated with increased cesarean risk among African American women: evidence from California, 2010. Am J Public Health. 2015;105:956–62.CrossRefGoogle Scholar
  22. 22.
    Hueston WJ, Applegate JA, Mansfield CJ, King DE, McClaflin RR. Practice variations between family physicians and obstetricians in the management of low-risk pregnancies. J Fam Pract. 1995;40:345–51.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Kozhimannil K, Arcaya MC, Subramanian SV. Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: analyses of national US hospital discharge database. PLoS Med. 2014;11:e1001745.CrossRefGoogle Scholar
  24. 24.
    Leeman LM, Beagle M, Espey E, Ogburn T, Skipper B. Diminishing availability of trial of labor after cesarean delivery in New Mexico hospitals. Obstet Gynecol. 2013;122(2):242–7.CrossRefGoogle Scholar
  25. 25.
    Little SE, Orav EJ, Robinson JN, Caughey AB, Jha AK. The relationship between variations in cesarean delivery and regional health care use in the United States. Am J Obstet Gynecol. 2016;214(6):735.e.1–8.CrossRefGoogle Scholar
  26. 26.
    Main EK, Morton C, Hopkins D, Giuliani G, Melsop K, Gould JB. Cesarean deliveries, outcomes, and opportunities for change in California: toward a public agenda for maternity care and safety. A CMQCC White Paper. 2011. Available online: https://www.cmqcc.org/resource/cesarean-deliveries-outcomes-and-opportunities-change-california-toward-public-agenda
  27. 27.
    Martin JA, Hamilton BE, Osterman MJ, Driscoll AK, Drake D. Births: final data for 2017. Nat Vit Stats Rep 2018;67(8). Hyattsville. National Center for Health Statistics. Available online: https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_08-508.pdf
  28. 28.
    Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Mathews TJ. Births: final data for 2015. Nat Vit Stats Rep. 2017;66(1). Hyattsville: National Center for Health Statistics. Available online: https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_01.pdf.
  29. 29.
    Martin JA, Hamilton BE, Osterman MJK. Births in the United States, 2014. NCHS Data Brief, no 216. Hyattsville: National Center for Health Statistics. 2015. Available online: https://www.cdc.gov/nchs/data/databriefs/db216.pdf.
  30. 30.
    McDonald JA, Amatya A, Gard CC, Sigala J. In states that border Mexico, cesarean rates were highest for Hispanic women living in border counties. Health Aff (Millwood). 2019;38(2):276–86.  https://doi.org/10.1377/hlthaff.2018.05369.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    McDonald JA, Amatya A, Gard CC, Sigala J. Trends in Hispanic and non-Hispanic white cesarean delivery rates on the US-Mexico border, 2000-2015. PLoS ONE. 2018;13:e0203550.  https://doi.org/10.1371/journal.pone.0203550.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    McDonald JA, Mojarro Davila O, Sutton PD, Ventura JS. Cesarean birth in the border region: a descriptive analysis based on US Hispanic and Mexican birth certificates. Matern Child Health J. 2015;19:112–20.CrossRefGoogle Scholar
  33. 33.
    Mistry K, Fingar KR, Elixhauser A. Variation in the rate of cesarean section across U.S. hospitals, 2013. HCUP Statistical Brief #211. September, 2016. Agency for Health Care Research and Quality, Rockville. Available online: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb211-Hispital-Variation-C-sections-2013.pdf.
  34. 34.
    Morris T, Gomez A, Naiman-Sessions M, Morton CH. Paradox lost on the U.S.-Mexico border: U.S. Latinas and cesarean rates. BMC Preg Childbirth. 2018;18:82.CrossRefGoogle Scholar
  35. 35.
    Morris T, McNamara K, Morton CH. Hospital-ownership status and cesareans in the United States: the effect of for-profit hospitals. Birth. 2017;44:325–30.CrossRefGoogle Scholar
  36. 36.
    National Center for Health Statistics. Natality data file (2015), as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Hyattsville: National Center for Health Statistics. Available online: https://www.cdc.gov/nchs/nvss/dvs_data_release.htm.
  37. 37.
    Sen B. Using the Oaxaca-Blinder decomposition as an empirical tool to analyze racial disparities in obesity. Obesity. 2014;22:1750–5.CrossRefGoogle Scholar
  38. 38.
    Shaw RJ, Pickett KE, Wilkinson RG. Ethnic density effects on birth outcomes and maternal smoking during pregnancy in the US linked birth and infant death data set. Am J Public Health. 2010;100:707–13.CrossRefGoogle Scholar
  39. 39.
    Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery. Obstet Gynecol. 2012;120:1181–93.PubMedPubMedCentralGoogle Scholar
  40. 40.
  41. 41.
    US Department of Health and Human Services. Healthy People 2020. Available online: www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives.
  42. 42.
    Walker LO, Cheng HR, Brown A. Birth outcomes of Hispanic women and risks or strengths associated with ethnicity and Texas border residence. J Obstet Gynecol Neonat Nurs. 2014;43:422–34.CrossRefGoogle Scholar
  43. 43.
    Woodbridge JM. Linear probability model for binary response. In: Econometric analysis of cross section and panel data. 2nd ed. Cambridge: MIT Press; 2010. p. 562e5.Google Scholar
  44. 44.
    Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gulmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. Brit J Obstet Gynecol. 2016;123:745–53.CrossRefGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Department of Public Health Sciences, College of Health and Social ServicesNew Mexico State UniversityLas CrucesUSA
  2. 2.Southwest Institute for Health Disparities Research, College of Health and Social ServicesNew Mexico State UniversityLas CrucesUSA
  3. 3.Department of Economics, College ofBusiness, Applied Statistics, and International BusinessNew Mexico State UniversityLas CrucesUSA

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