public-health-congress-2017-posters-abstracts

20 / 23

Page 56
conferenceseries.com
Volume 7, Issue 5 (Suppl) J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal Public Health Congress 2017
November 13-14, 2017
November 13-14, 2017 Osaka, Japan
3rd World Congress on
Public Health, Nutrition & Epidemiology
Disparities in caesarean section (C-section) rates by maternal socioeconomic status (SES) across
diverse obstetric indications
Kamala Adhikari Dahal1, Deborah A McNeil1,2, Sheila McDonald1,2, Alka B Patel1,2 and Amy Metcalfe1
1University of Calgary, Canada
2Alberta Health Services, Canada
Introduction & Aim: The existing inconsistent association between C-section rate and SES may be due to not analyzing the
association across obstetric-indications for C-sections. This study examined the variation in C-section rates by maternal SES
across diverse-obstetric-indications.
Methods: This was a cross-sectional study design that used the 2015 US Birth Certificate data. Data on demographics, SES
(education and insurance status), medical conditions (e.g., diabetes, hypertension and eclampsia) and obstetric characteristics
(e.g., parity and fetal presentation) were extracted. C-section rate and its association with SES adjusting for maternal age and
medical conditions using multivariable log-binomial regression models were examined across 10 clinically-relevant-obstetric-
groups for C-sections (Robson’s 10-group).
Results: The overall C-section rate was 32.0%, with up to 34.1% for those women with high SES (i.e., highest education
attainment or private insurance) and 26.6% for those with low SES (lowest education attainment or Medicaid/no private
insurance and Medicaid). Ranging from 5% to 9%, the discrepancy in C-section rate between women with high and low
SES was observed across all 10-obstertic groups, even in the presence of medical conditions such as eclampsia. Importantly,
SES was significantly associated with the risk of C-section across 10-obstertic-groups, with varied direction/magnitude of
associations. Women with graduate education compared to those who did not complete high school were more likely to have
a C-section (RR: 2.4, 95% CI: 2.3-2.4) for low-risk conditions (group-1). Whereas, they were less likely to have C-section (RR:
0.7, 95% CI: 0.6-0.9) for a strongly medically-indicated-obstetric condition (group 9: abnormal fetal lies). Women without
private insurance or Medicaid coverage were less likely to have C-section in almost all obstetric groups.
Conclusion: The unequal distribution of C-sections across maternal SES exists regardless of maternal age and medical
conditions. This finding will draw clinicians’ attention towards more equitable meeting of healthcare needs of women regardless
of their SES.
J Community Med Health Educ 2017, 7:5 (Suppl)
DOI: 10.4172/2161-0711-C1-031