Abstract
INTRODUCTION: With rising rates of caesarean section (CS) in Canada and worldwide, non-clinical factors for CS warrant consideration. Our objective was to determine the association between a primigravid woman's neighborhood income and rates of CS. METHODS: A retrospective cohort study was conducted at an Ontario tertiary care center from January 2003 to December 2013. Rates of CS were determined using data collected from the Discharge Abstract Database. Women with singleton live births were included. The main exposure variable was neighborhood income quintile. A multivariable model was used to adjust for covariates and provide an estimate of the independent effect of neighborhood income on CS rate. RESULTS: The study cohort comprised 32,714 women. Compared with the lowest quintile, women in the highest quintile had increased rates of CS (Relative Risk (RR) 1.06, 95% Confidence Interval (CI) [1.02, 1.11]). Following adjustment for important confounders, there was no longer an association between neighborhood income and CS rate (adjusted RR 1.00, 95% CI [0.99-1.01]). Women in the highest quintile were more likely to have greater maternal age (P<0.001). CONCLUSION: Although differences in CS rates are seen by neighborhood income quintile, they appear to be related to maternal and infant clinical factors. Neighborhood income does not appear to be an independent predictor of CS.
Published Version
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