The Association of Socioeconomic Variables with Cesarean Section: A
Retrospective Study
Abstract
o Objective: To probe the relationship between socioeconomic variables
and cesarean section (CS) by studying indicators of socioeconomic status
(SES) previously unexamined in the United States (US). o Design:
Retrospective review of government data. o Setting: New York City. o
Population or Sample: Women (n=80,506) who gave birth to a live child
during 2018. o Methods: Analysis of data from the New York City
Department of Health and Mental Hygiene and from the US census. o Main
Outcome Measures: Presence of CS. o Results: Multivariate logistic
regression analysis showed higher odds for CS for higher median
household income [US$54,500-$108,499 (OR:1.14, 95% CI:1.02, 1.28,
p=0.03) and US$108,500-$380,499 (OR:1.36, 95% CI:1.14, 1.63,
p<0.001)], and percent receiving supplemental nutrition
assistance program (OR:1.01, 95% CI 1.002, 1.01, p=0.003). Lower odds
for CS occurred for per capita income [US$32,500-$54,499 (OR:0.91,
95% CI:0.86, 0.97, p=0.002), US$54,500-$108,499 (OR:0.79, 95%
CI:0.71, 0.88, p<0.001), and US$108,500-$380,499 (OR:0.82,
95% CI:0.71, 0.94, p=0.01)]. No significant association occurred for
public assistance. o Conclusions: We recommend from a public health
perspective that using neighborhood SES information has the potential to
improve health systems to better deliver care. Patient preferences may
be related to SES. There may be conflicts between obstetric care that is
maximally beneficial and patient’s desire for delivery mode. Clinicians
should be aware of the potential implications of this dilemma.