Association of race and ethnicity in cesarean rates in a diverse low-risk populationAssociation of race and ethnicity in cesarean rates in a diverse low-risk population

Abstract

Objective To evaluate racial disparities in cesarean delivery rates in an ethnically diverse nulliparous, term, singleton, vertex (NTSV) population at an inner-city tertiary care center. Methods This is a retrospective cohort study evaluating cesarean delivery rates by race and ethnicity in an ethnically diverse NTSV population with approximately equal numbers of Hispanic, non-Hispanic Black and non-Hispanic White participants from January 1st through December 31st, 2020. The primary outcome was cesarean delivery rate. The secondary outcome was urgency of cesarean delivery categorized as emergent, unscheduled or elective. Univariable analysis was utilized to evaluate the association of maternal clinical characteristics and the primary and secondary outcomes. Multivariable analysis was performed for variables significant in univariable analysis (p <0.05). Results A total of 872 patients were included in the study. 290 were non-Hispanic White (33.3%), 258 were non-Hispanic Black (29.6%), 245 were Hispanic (28.1%), and 79 were Asian (9.1%). The overall cesarean rate was 32.5%. The cesarean delivery rates for non-Hispanic White, non-Hispanic Black, Hispanic, and Asian patients were 26.6%, 40.7%, 31.4%, and 30.4%, respectively. Non-Hispanic Black patients had significantly higher odds of cesarean delivery when compared to non-Hispanic White patients (OR 1.96, 95% CI: 1.37-2.81). This increased risk persisted in the multivariable analysis (aOR 1.83, 95% CI: 1.13-2.97). The risk of emergent cesarean delivery for non-Hispanic Black patients was also significantly increased (OR 3.69, 95% CI: 2.28-5.75), (aOR 3.39, 95% CI: 1.90-6.05). Conclusion Non-Hispanic Black patients had significantly higher risk of cesarean delivery and emergent cesarean delivery when compared to non-Hispanic White patients in an NTSV population at an inner-city tertiary care center.