261858 A Systematic Review of Racial and Ethnic Disparities in Cesarean Sections in the United States

Sunday, October 28, 2012

Joyce Edmonds, RN, MPH, PhD , William F. Connell School of Nursing, Boston College, Chestnut Hill, MA
Audrey Jasey, RN , College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA
Purpose: To evaluate what is known about the variation in cesarean delivery rates by race and ethnicity in the United States (US) in order to identify trends, gaps in knowledge, and directions for future research. Background: Cesarean sections (CS) are the most common surgical procedure for women in the US. Of the over 4 million births a year, one in three is now delivered in this manner and the risk adjusted prevalence rates appear to vary by race and ethnicity. However, data from individual studies provides limited or contradictory information on race and ethnicity as an independent predictor of delivery mode. Methods: A systematic review of the scientific literature was conducted. Peer-reviewed observational studies, published from 1995 to 2011, that contained comparative analyses of CS rates among two or more racial/ethnic groups were examined. Data were analyzed descriptively and where possible, meta-analyzed. Results: Twenty-five studies met the inclusion criteria. The patterns of findings suggest that certain racially and ethnically defined populations are at greater odds of cesarean while others have equivalent or lower risk adjusted rates. Disproportionately higher risk-adjusted rates are consistently seen among black and/or African American women relative to white non-Hispanic women although heterogeneity among studies was a limiting factor. Conclusion and Implications: Studies are needed to understand the mechanisms by which race and ethnicity differentially influence CS rates. Public health nurses are positioned to target interventions aimed at reducing disparities in CS through surveillance, birth preparation classes, and implementation of evidenced based guidelines.

Learning Areas:
Public health or related nursing
Public health or related research

Learning Objectives:
Identify racial and ethnic disparities in cesarean section rates in the United States Evaluate the variation in risk adjusted cesarean section rates by race and ethnicity Discuss directions for future research on disparities in cesarean section rates

Keywords: Maternal Health, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator on a federally funded training grant focusing on maternal health. Among my scientific interests has been the causes of the rising rates of cesarean sections.
Any relevant financial relationships? No

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.