Racial and ethnic disparities in cesarean deliveries among women with chronic health conditions

Background: Rates of cesarean section (c/s) deliveries have increased 53% from 20.7% in 1996 to 32% in 2007 with variations by race and ethnicity. Simultaneously prevalence in chronic diseases has risen and racial and ethnic disparities persist. The purpose of this study was to determine if whether racial and ethnic disparities in c/s exist among women with chronic conditions. Methods: Using 2007-2009 U.S. Natality files, we selected singleton live births to primiparous U.S. resident mothers; we focused our analyses to women with primary c/s deliveries. We calculated primary cesarean delivery rates by race and ethnicity as well as unadjusted and adjusted odds ratios of c/s delivery among women with hypertensive disorders and diabetes. Non-Hispanic white (white) was used as the reference group, controlling for sociodemographic and other perinatal or maternal risk factors.

Results: The proportions of c/s delivery among all women with hypertensive disorders and diabetes was higher (47.4% and 46.4%, respectively) than overall; among black mothers, it was 51.2% and 53.9% respectively, higher than whites (46.7% and 46.6%). The overall odds of c/s is higher among black women (aOR=1.29, 95% CI=1.29-1.30) compared to white women. For hypertensive disorder, the odds are 1.25 (95% CI=1.22-1.28) and for diabetes, 1.37 (95% CI=1.32-1.42).

Conclusions: Black women had higher rates and odds of primary c/s. This disparity was similar among women identified with chronic conditions, controlling for other maternal, infant, and sociodemographic risk factors. These findings might suggest differential care among these populations or reflect some measure of severity related to condition.