4.5 Article

Variation and racial/ethnic disparities in Cesarean delivery at New York City hospitals: the contribution of hospital-level factors

Journal

ANNALS OF EPIDEMIOLOGY
Volume 73, Issue -, Pages 1-8

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.annepidem.2022.06.003

Keywords

Cesarean delivery; Racial; ethnic disparities; Multilevel regression; General contextual effects; Specific contextual effects; Hospital -level factors

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This study aimed to quantify the contextual effects associated with Cesarean delivery at New York City hospitals, finding that the association between hospital characteristics and Cesarean delivery differed by maternal race/ethnicity. The results showed that delivery in teaching hospitals reduced the odds of Cesarean delivery for White and Asian women, but not for Black or Hispanic women. Hospital ownership and caseloads were not associated with Cesarean delivery for any group.
Purpose: We aimed to quantify general and specific contextual effects associated with Cesarean delivery at New York City hospitals, overall and by maternal race/ethnicity.Methods: Among 127,449 singleton, nulliparous births at New York City hospitals from 2015 to 2017, we used multilevel logistic regression to examine the association of hospital characteristics (public/private ownership, teaching status and delivery caseloads) with Cesarean delivery, overall, and by maternal race/ethnicity. We estimated the intra-class correlation to examine general contextual effects and 80% interval odds ratios (IOR) and percentage of opposed odds ratios (POOR) to examine specific contextual effects.Results: Overall, 27.8% of births were Cesareans. The general contextual (hospital) effect on Cesarean de-livery was small (intra-class correlation: 1.8%). Hospital characteristics associated with Cesarean delivery differed by maternal race/ethnicity, with delivery in teaching hospitals reducing the odds of Cesarean de-livery among White (IOR: 0.31, 0.86; POOR: 4.7%) and Asian women (IOR: 0.41, 0.95; POOR: 7.3%), but not among Black (IOR: 0.51, 1.34; POOR: 30.7%) or Hispanic women (IOR: 0.44, 1.24; POOR: 22.6%). Hospital ownership and caseloads were not associated with Cesarean delivery for any group.Conclusions: There is little within-hospital clustering of Cesarean delivery, suggesting that Cesarean dis-parities may not be explained by hospital of delivery.(c) 2022 Elsevier Inc. All rights reserved.

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