Effects of maternal characteristics on cesarean rates among U.S. department of defense healthcare beneficiaries, 1996 to 2002

Abstract

Purpose Cesarean rates and trends for the Department of Defense (DoD) healthcare beneficiary population from 1996 to 2002 were compared with those observed nationally. The associations between cesarean use and maternal age, race, socioeconomic status, and insurance coverage were also examined within the DoD healthcare beneficiary population. Methods Hospital discharge and claims records for babies born in the military and civilian hospitals that comprise the DoD healthcare network were used to calculate total and primary cesarean rates and vaginal birth after cesarean rates. Annual rates for subgroups defined by maternal age, race, and socioeconomic status were calculated to examine rate variations and trends within the study population. Pooled data from 1999 to 2002 were used to compare rates across socioeconomic status, stratified by age and race. Statistical significance of the differences calculated for subgroups was assessed using χ2. Results Total and primary cesarean rates increased over time among the DoD population, but were lower than those reported nationally for every year examined. Within the DoD population, total cesarean delivery increased with increasing maternal age and was more highly associated with racial minorities relative to white women. The higher socioeconomic subgroup (defined as officer personnel and their families) was generally associated with reduced cesarean section rates. Conclusion Cesarean deliveries are performed less frequently for the DoD healthcare beneficiary population, relative to the national population. Associations between socioeconomic factors and cesarean rates reported for the national population were not apparent in the DoD population. The consistent pattern of rate variation across racial subgroups in the DoD population suggests that factors beyond those examined in this study are needed to explain the elevated cesarean rates for racial minorities.