Urbanization and the likelihood of a cesarean section
Received 14 February 2008; received in revised form 30 April 2008; accepted 3 July 2008. published online 11 August 2008.
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.
ABSTRACT