Urbanization and the likelihood of a cesarean section

Chin Shyan Chen, Herng Ching Lin, Tsai Ching Liu, Shiyng-Yu Lin, Stefani Pfeiffer

研究成果: 雜誌貢獻文章

13 引文 (Scopus)

摘要

Objective: This study examines the association between the likelihood of cesarean section (CS) and the degree of urbanization in Taiwan, exploring possible explanations for the difference. Study design: The database used in this study was the Taiwan 2004 National Health Insurance Research Database. A total of 200,207 singleton deliveries fulfilled our criteria and were included in our study. The urbanization level of cities/towns where parturients resided at the time of delivery was stratified into seven categories. A multilevel logistic regression model was applied to examine the relative likelihood of CS by urbanization level after adjusting for parturient, physician and hospital characteristics. Results: There was an upward trend in the CS rate with advancing urbanization level; the CS rates for urbanization level 1 (most urbanized) through 7 (least urbanized) were 33.7, 32.3, 30.4, 30.2 29.7, 29.5, and 28.6%, respectively. Compared with participants living at the highest urbanization level, the adjusted odds of a CS were 0.91 (95% CI = 0.85-0.98, p = 0.014), 0.84 (95% CI = 0.78-0.91, p <0.001), 0.83 (95% CI = 0.68-0.88, p <0.001), 0.79 (95% CI = 0.72-0.86, p <0.001), and 0.70 (95% CI = 0.62-0.80, p <0.001) times, respectively, for those living in cities/towns ranked from the third highest to the lowest levels of urbanization. Conclusions: We conclude that higher urbanization levels were associated with higher odds of CS. Highly urbanized communities could therefore be targeted for policy intervention aimed at reducing the unnecessary CS rate.

原文英語
頁(從 - 到)104-110
頁數7
期刊European Journal of Obstetrics Gynecology and Reproductive Biology
141
發行號2
DOIs
出版狀態已發佈 - 十二月 2008

指紋

Urbanization
Cesarean Section
Taiwan
Logistic Models
Parturition
Databases
National Health Programs
Physicians
Research

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Reproductive Medicine

引用此文

Urbanization and the likelihood of a cesarean section. / Chen, Chin Shyan; Lin, Herng Ching; Liu, Tsai Ching; Lin, Shiyng-Yu; Pfeiffer, Stefani.

於: European Journal of Obstetrics Gynecology and Reproductive Biology, 卷 141, 編號 2, 12.2008, p. 104-110.

研究成果: 雜誌貢獻文章

Chen, Chin Shyan ; Lin, Herng Ching ; Liu, Tsai Ching ; Lin, Shiyng-Yu ; Pfeiffer, Stefani. / Urbanization and the likelihood of a cesarean section. 於: European Journal of Obstetrics Gynecology and Reproductive Biology. 2008 ; 卷 141, 編號 2. 頁 104-110.
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abstract = "Objective: This study examines the association between the likelihood of cesarean section (CS) and the degree of urbanization in Taiwan, exploring possible explanations for the difference. Study design: The database used in this study was the Taiwan 2004 National Health Insurance Research Database. A total of 200,207 singleton deliveries fulfilled our criteria and were included in our study. The urbanization level of cities/towns where parturients resided at the time of delivery was stratified into seven categories. A multilevel logistic regression model was applied to examine the relative likelihood of CS by urbanization level after adjusting for parturient, physician and hospital characteristics. Results: There was an upward trend in the CS rate with advancing urbanization level; the CS rates for urbanization level 1 (most urbanized) through 7 (least urbanized) were 33.7, 32.3, 30.4, 30.2 29.7, 29.5, and 28.6{\%}, respectively. Compared with participants living at the highest urbanization level, the adjusted odds of a CS were 0.91 (95{\%} CI = 0.85-0.98, p = 0.014), 0.84 (95{\%} CI = 0.78-0.91, p <0.001), 0.83 (95{\%} CI = 0.68-0.88, p <0.001), 0.79 (95{\%} CI = 0.72-0.86, p <0.001), and 0.70 (95{\%} CI = 0.62-0.80, p <0.001) times, respectively, for those living in cities/towns ranked from the third highest to the lowest levels of urbanization. Conclusions: We conclude that higher urbanization levels were associated with higher odds of CS. Highly urbanized communities could therefore be targeted for policy intervention aimed at reducing the unnecessary CS rate.",
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N2 - Objective: This study examines the association between the likelihood of cesarean section (CS) and the degree of urbanization in Taiwan, exploring possible explanations for the difference. Study design: The database used in this study was the Taiwan 2004 National Health Insurance Research Database. A total of 200,207 singleton deliveries fulfilled our criteria and were included in our study. The urbanization level of cities/towns where parturients resided at the time of delivery was stratified into seven categories. A multilevel logistic regression model was applied to examine the relative likelihood of CS by urbanization level after adjusting for parturient, physician and hospital characteristics. Results: There was an upward trend in the CS rate with advancing urbanization level; the CS rates for urbanization level 1 (most urbanized) through 7 (least urbanized) were 33.7, 32.3, 30.4, 30.2 29.7, 29.5, and 28.6%, respectively. Compared with participants living at the highest urbanization level, the adjusted odds of a CS were 0.91 (95% CI = 0.85-0.98, p = 0.014), 0.84 (95% CI = 0.78-0.91, p <0.001), 0.83 (95% CI = 0.68-0.88, p <0.001), 0.79 (95% CI = 0.72-0.86, p <0.001), and 0.70 (95% CI = 0.62-0.80, p <0.001) times, respectively, for those living in cities/towns ranked from the third highest to the lowest levels of urbanization. Conclusions: We conclude that higher urbanization levels were associated with higher odds of CS. Highly urbanized communities could therefore be targeted for policy intervention aimed at reducing the unnecessary CS rate.

AB - Objective: This study examines the association between the likelihood of cesarean section (CS) and the degree of urbanization in Taiwan, exploring possible explanations for the difference. Study design: The database used in this study was the Taiwan 2004 National Health Insurance Research Database. A total of 200,207 singleton deliveries fulfilled our criteria and were included in our study. The urbanization level of cities/towns where parturients resided at the time of delivery was stratified into seven categories. A multilevel logistic regression model was applied to examine the relative likelihood of CS by urbanization level after adjusting for parturient, physician and hospital characteristics. Results: There was an upward trend in the CS rate with advancing urbanization level; the CS rates for urbanization level 1 (most urbanized) through 7 (least urbanized) were 33.7, 32.3, 30.4, 30.2 29.7, 29.5, and 28.6%, respectively. Compared with participants living at the highest urbanization level, the adjusted odds of a CS were 0.91 (95% CI = 0.85-0.98, p = 0.014), 0.84 (95% CI = 0.78-0.91, p <0.001), 0.83 (95% CI = 0.68-0.88, p <0.001), 0.79 (95% CI = 0.72-0.86, p <0.001), and 0.70 (95% CI = 0.62-0.80, p <0.001) times, respectively, for those living in cities/towns ranked from the third highest to the lowest levels of urbanization. Conclusions: We conclude that higher urbanization levels were associated with higher odds of CS. Highly urbanized communities could therefore be targeted for policy intervention aimed at reducing the unnecessary CS rate.

KW - Cesarean section

KW - Taiwan

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