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. 2013;8(3):e57817.
doi: 10.1371/journal.pone.0057817. Epub 2013 Mar 18.

Hospital differences in cesarean deliveries in Massachusetts (US) 2004-2006: the case against case-mix artifact

Isabel A Cáceres  1 , Mariana Arcaya, Eugene Declercq, Candice M Belanoff, Vanitha Janakiraman, Bruce Cohen, Jeffrey Ecker, Lauren A Smith, S V Subramanian
Affiliations

Hospital differences in cesarean deliveries in Massachusetts (US) 2004-2006: the case against case-mix artifact

Isabel A Cáceres et al. PLoS One. 2013.

Abstract

Objective: We examined the extent to which differences in hospital-level cesarean delivery rates in Massachusetts were attributable to hospital-level, rather than maternal, characteristics.

Methods: Birth certificate and maternal in-patient hospital discharge records for 2004-06 in Massachusetts were linked. The study population was nulliparous, term, singleton, and vertex births (NTSV) (n = 80,371) in 49 hospitals. Covariates included mother's age, race/ethnicity, education, infant birth weight, gestational age, labor induction (yes/no), hospital shift at time of birth, and preexisting health conditions. We estimated multilevel logistic regression models to assess the likelihood of a cesarean delivery.

Results: Overall, among women with NTSV births, 26.5% births were cesarean, with a range of 14% to 38.3% across hospitals. In unadjusted models, the between-hospital variance was 0.103 (SE 0.022); adjusting for demographic, socioeconomic and preexisting medical conditions did not reduce any hospital-level variation 0.108 (SE 0.023).

Conclusion: Even after adjusting for both socio-demographic and clinical factors, the chance of a cesarean delivery for NTSV pregnancies varied according to hospital, suggesting the importance of hospital practices and culture in determining a hospital's cesarean rate.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Unadjusted Cesarean Delivery Rates Among Nulliparous, Term, Singleton, Vertex (NTSV) Births in 49 Maternity Hospitals in Massachusetts (US), Massachusetts 2004–2006.
Figure 2
Figure 2. Between-hospital Variation in Cesarean Deliveries with Different Case-mix Adjustment, Massachusetts 2004–2006 NTSV Births.
Figure 3
Figure 3. Hospital-specific Odds Ratios of Cesarean Deliveries, Null and Adjusted Models.
See this image and copyright information in PMC

References

    1. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, et al. (2010) Births: final data for 2008. Natl Vital Stat Rep 59: 1, 3–71. - PubMed
    1. Menacker F, Hamilton BE (2010) Recent trends in cesarean delivery in the United States. NCHS Data Brief 1–8. - PubMed
    1. Health MDoP (2009) Massachusetts Births 2009. Research, and Evaluation, Massachusetts Department of Public Health, Boston, MA.
    1. MacDorman MF, Declercq E, Menacker F, Malloy MH (2008) Neonatal mortality for primary cesarean and vaginal births to low-risk women: application of an “intention-to-treat” model. Birth 35: 3–8 doi:10.1111/j.1523-536X.2007.00205.x - DOI - PubMed
    1. Kuklina EV, Meikle SF, Jamieson DJ, Whiteman MK, Barfield WD, et al. (2009) Severe obstetric morbidity in the United States: 1998–2005. Obstet Gynecol 113: 293–299 doi:10.1097/AOG.0b013e3181954e5b - DOI - PMC - PubMed

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