Disparities in Incidences of Cesarean Section Among Women With Gestational Diabetes Mellitus in the United States

Abstract

Background In this study, we explored the interaction between women's race/ethnicity and insurance type and determined how these interactions affect the incidences of cesarean section (CS) among women with gestational diabetes mellitus (GDM). Methodology We utilized the National Inpatient Sample (NIS) database from January 2000 to September 2015 to conduct a retrospective analysis of all GDM-associated hospitalizations. We then explored the interaction between race/ethnicity and insurance types and determined how these interactions affect the incidences of CS among GDM patients, controlling for traditional risk factors for CS and patients' sociodemographics. Subsequently, we determined the risk of primary postpartum hemorrhage (PPH) in the CS group and a propensity score-matched control group who had vaginal deliveries. Results There were 932,431 deliveries diagnosed with GDM in the NIS database from January 2000 to September 2015. The mean age of the study population was 30.6 ± 5.9 years, 44.5% were white, 14.0% were black, and 26.7% were Hispanic. The CS rate was 40.5%. After controlling for covariates, women who utilized private insurance had the highest CS rate across the different races/ethnicities; white (odds ratio (OR) = 1.21 (1.17-1.25)) blacks (OR = 1.33 (1.26-1.41)), and Hispanic (OR = 1.12 (1.06-1.18)). CS patients were less likely to develop PPH compared to their matched controls with vaginal deliveries (OR = 0.67 (0.63-0.71)). Conclusions Private insurance is associated with higher incidences of CS among women with GDM, irrespective of race/ethnicity.

Keywords: cesarean section; disparity; gestational diabetes mellitus; insurance type; race/ethnicity.

Figure 1. Interaction between race/ethnicity and insurance types and association with incidence of cesarean section (2000-2015).

x: interaction term analysis