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Racial Differences in Cesareans: An Analysis of U.S. 2001 National Inpatient Sample Data

Azad A. Kabir, MB, MSPH^*, Gabriella Pridjian, MD, William C. Steinmann, MD, MSc, Eduardo A. Herrera, MD and M. Mahmud Khan, PhD

From the Departments of *Epidemiology and Health System Management, Tulane University School of Public Health and Tropical Medicine; Department of Obstetrics & Gynecology, Tulane University School of Medicine; and Tulane Center for Clinical Effectiveness and Prevention, Tulane University School of Medicine, New Orleans, Louisiana.

OBJECTIVE: To evaluate racial differences in potentially unnecessary cesareans in the United States.

METHODS: The 2001 Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to analyze various maternal demographic and clinical parameters among women having cesarean deliveries. For the purpose of our study, if there were no diagnoses related to cesarean delivery on the discharge certificate, the cesarean was classified as potentially unnecessary

RESULTS: Using our methodology, 11% of 540,174 primary and 65% of 371,863 repeat cesareans for the year 2001 in the United States were classified as potentially unnecessary. After controlling for age, payment source, ZIP income, admission day, region of the country, and hospital size, location, and teaching status, black women had a higher likelihood of having potentially unnecessary primary cesareans when compared with white (P < .001) or Hispanic women (P < .001). White women had a higher likelihood of having potentially unnecessary repeat cesareans than black women (P < .001), although the magnitude of the odds ratio for race was not as striking as in primary cesarean. Potentially unnecessary primary cesareans were also more likely to occur in women aged 35 years or older, Medicare patients, weekend admissions, or those residing in the South or Northeast. Potentially unnecessary repeat cesareans were more likely to occur in women younger than 35 years, in rural hospitals, and in weekday admissions.

CONCLUSION: In the United States, racial differences exist in the proportion of cesarean deliveries that are potentially unnecessary. Further exploration of these differences is warranted.

LEVEL OF EVIDENCE: III

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