Causes of Racial and Ethnic Disparities in Primary Cesarean Section Rates

While U.S. cesarean rates have risen to 31.1% overall and 22.1% for primary cesareans in 2006, little attention has been paid to race-ethnicity disparities in these rates. Black non-Hispanic (BNH) mothers have the highest primary cesarean rate (24.1% ) among major race/ethnicity groups in the U.S. compared to 22.6% for white non-Hispanic (WNH) mothers and 19.9% for Hispanic mothers. The major question in this study is whether or not differences in primary cesarean rates by race/ethnicity can be explained by medical risk factors and/or other demographic characteristics.

This study relies on two data sources. U.S. national natality data from 2006, will be used for background and context. The Pregnancy to Early Life Longitudinal Database of Massachusetts births from 1998-2005 links birth certificate to hospital discharge data and includes additional variables (e.g. insurance status) and allows for more refined measurement of key variables.

Initial analysis finds black non-Hispanic mothers in Massachusetts from 1998-2005 had higher primary cesarean rates compared to white non-Hispanic across almost all major demographic subgroups, including insurance status; education, age, parity and hospital size. Black non-Hispanic mothers with no identified medical risks also had higher primary cesarean rates. There were two notable exceptions: nativity, with US born BNH mothers in Massachusetts having slightly lower cesarean rates than WNH mothers (unlike US national data); and WNH mothers had higher primary cesarean rates for gestational ages less than 39 weeks.

Variance in primary cesarean rates by race ethnicity persist across most demographic and medical risk groups.