(SDAR) Linked Dataset Analysis of Disparities in Cesarean Delivery Rates on the U.S. - Mexican Border
Grantee: New Mexico State University
Principal Investigator: Jill McDonald
Project Number: R40MC30756
Project Date: 4/01/17
Final Report
Age group(s)
- Women/Maternal
- Perinatal/Infancy (0-12 months)
Abstract
The US-Mexico border region is an impoverished, underserved, largely Hispanic set of communities in California, Arizona, New Mexico, and Texas. It has high birth rates and high cesarean delivery (CD) rates (~40%) among Hispanic women of childbearing age. This analysis will determine the maternal, infant, hospital, and environmental factors that result in high CD rates. The work is aligned with Title V MCH National Performance Domain #2 (Low-risk Cesareans or LRC); MCHB Strategic Research Issue II on elimination of health disparities and Issue IV on promoting healthy development of MCH populations; and Healthy People 2020 objectives MICH 7.1, "Reduce CD among lowrisk women with no prior CD" and MICH 7.2, "Reduce CD among low-risk women with a prior CD." The project has 3 aims: 1) conduct a descriptive analysis of CD in the border region that will build on earlier work by the PI; 2) explain the disparities between border Hispanics and non-border Hispanics in the four border states and between Hispanics and non-Hispanic whites (NHW) within the border region, and 3) explain the variation in rates of all CD, low risk primary CD, low risk primary CD in nulliparous women and low risk repeat CD among all counties in the border states. The study population is all women delivering live born infants in the border states during 2000-2015. The geographic unit of analysis is the county. The datasets are birth certificate files, HRSA Area Health Resources File for community characteristics, the American Hospital Association Survey Database of hospital characteristics and the HCUPnet database for overall health care utilization. By aim, the methods are: 1) calculate crude prevalence rates and trends for all four CD outcomes; 2) examine bivariate differences in the distributions of demographic, environmental, medical, behavioral, prenatal, labor and delivery, and hospital factors between border and non-border county Hispanic populations and between Hispanic and NHWs within the border region by using simple two-groups comparison methods; and identify a set of factors that explain the largest proportion of variance in CD outcomes accounted for by border residence and ethnicity; 3) explain the variation in CD rates among all counties in the border states by using multivariable linear regression to model CD rate as a function of county of residencelevel environmental factors and county of birth-level hospital factors, and quantify the amount of variation explained by each variable and each group of variables.Publications
Listed is descending order by year published.
McDonald JA, Amatya A, Gard CC, Sigala J. In states that border Mexico, cesarean rates were highest for Hispanic women living in border counties in 2015. Health Aff (Millwood). 2019;38(2):276-286.
McDonald JA, Amatya A, Gard CC, Sigala J. Trends in Hispanic and non-Hispanic white cesarean delivery rates on the US-Mexico border, 2000-2015. PLOS One. 2018 Sep 5;13(9):e0203550.
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