Mind the Gap: Exploring Risk Factors for High C-Sections Rates in Georgia
Abstract
Introduction: The World Health Organization recommends a national cesarean section rate of 10-15%. Georgia is one of several states that has a higher than recommended C-section rate of 35.1%. There is a growing concern that c-sections are no longer performed only out of medical necessity but by choice instead. The purpose of this study was to examine differences in elective c-section rates based on socioeconomic factors and whether selected socioeconomic factors increased the odds of c-sections among women in Georgia.
Methods: Data from CDC Wonder was used to identify all singleton live births with greater than 39 weeks gestation resulting from a first pregnancy (primipara) for women ages 15-44 with no prenatal risk factors from 2016-2022. Odds ratios and 95% confidence intervals were calculated to assess the association between demographic characteristics, insurance status, urbanicity, and prevalent c-section data.
Results: Out of 151,589 deliveries, 42,754 women (28.2%) had a c-section. African American/Black women had 1.16 (95% CI 1.14,1.19) times the odds of having a c-section compared to white women. Women covered by Medicaid had 18% lower odds (95% CI 0.8,0.84) of having a c-section compared to those with private insurance. Women residing in urban areas showed no significant increased odds of c-section compared to women residing in rural areas.
Conclusion: While identifying elective c-section data was severely limited with accessible data, higher overall rates among African American/Black and those women covered by private insurance may suggest higher elective c-section rates in these groups. Understanding the socioeconomic risk factors for c-section is important as c-section rates in the United States continue to increase. Implicit bias influencing health care practices still exist in modern day medicine and need to be examined as a potential influence to elective c-sections among BIPOC populations
Keywords
Cesarean section, Primipara, Socioeconomic risk factors
Mind the Gap: Exploring Risk Factors for High C-Sections Rates in Georgia
Introduction: The World Health Organization recommends a national cesarean section rate of 10-15%. Georgia is one of several states that has a higher than recommended C-section rate of 35.1%. There is a growing concern that c-sections are no longer performed only out of medical necessity but by choice instead. The purpose of this study was to examine differences in elective c-section rates based on socioeconomic factors and whether selected socioeconomic factors increased the odds of c-sections among women in Georgia.
Methods: Data from CDC Wonder was used to identify all singleton live births with greater than 39 weeks gestation resulting from a first pregnancy (primipara) for women ages 15-44 with no prenatal risk factors from 2016-2022. Odds ratios and 95% confidence intervals were calculated to assess the association between demographic characteristics, insurance status, urbanicity, and prevalent c-section data.
Results: Out of 151,589 deliveries, 42,754 women (28.2%) had a c-section. African American/Black women had 1.16 (95% CI 1.14,1.19) times the odds of having a c-section compared to white women. Women covered by Medicaid had 18% lower odds (95% CI 0.8,0.84) of having a c-section compared to those with private insurance. Women residing in urban areas showed no significant increased odds of c-section compared to women residing in rural areas.
Conclusion: While identifying elective c-section data was severely limited with accessible data, higher overall rates among African American/Black and those women covered by private insurance may suggest higher elective c-section rates in these groups. Understanding the socioeconomic risk factors for c-section is important as c-section rates in the United States continue to increase. Implicit bias influencing health care practices still exist in modern day medicine and need to be examined as a potential influence to elective c-sections among BIPOC populations
