577 Foreign born women have higher cesarean delivery rates than US born women

Abstract

To compare cesarean delivery rates in the US separated by ethnicity, race, and maternal birthplace. Retrospective analysis of the Centers for Disease Control and Prevention, Natality Live Birth database (2016-2018). We calculated cesarean delivery rates for nulliparous, term, vertex, singleton (NTSV) pregnancies separately by ethnicity, by maternal race, and whether the mother was born in the US (US born) or outside the US (foreign). We included four groups: Non-Hispanic whites (NHW), non-Hispanic blacks (NHB), Hispanic whites (HW), Hispanic blacks (HB). The cesarean delivery rate (CDR) of US born mothers was set as the reference. Results were presented as Odds Ratios (OR) with 95% confidence intervals (CI). The study included a total of 2,768,968 pregnancies with an overall CDR of 25.7%. Foreign-born mothers had a small but significantly higher CDR when compared to US-born mothers (27.57% versus 25.45%, OR 1.12, 95%CI: 1.11-1,12). Foreign-born NHB overall had the highest CDR of all groups and had a significantly higher CDR compared to US-born NHB (34.89% vs 29.44%, OR: 1.28, 95%CI: 1.26,1.3). The CDR for US-born blacks was lower when foreign-born NHB were separated from the conflated Hispanic rates. It is important to better understand why there are such discrepancies in pregnancy outcomes in the US. In usual CDR reports both black and white races for Hispanics and birthplace of the mother are conflated. When we separated the conflated rates of US and foreign-born NH pregnancies, we found for the first time that foreign-born NHB mothers had significantly higher CDR compared to US-born mothers. Combining races for Hispanics and not separating birth locations potentially confuses the understanding of outcomes of different races and ethnicities in the US. For example, we need a better understanding why foreign-born NHB have an 18.5% higher CDR than US-born NHB. We recommend that to better understand differences in CDR, pregnancies are separated by ethnicity, by race, and by birth location.View Large Image Figure ViewerDownload Hi-res image Download (PPT)