Evaluation of Cesarean Rates for Term, Singleton, Live Vertex Deliveries in China in 2020 Among Women With No Prior Cesarean Delivery

Author:

Yin Shaohua123,Chen Lian123,Zhou Yubo4,Yuan Pengbo12,Guo Xiaoyue12,Lu Jie123,Ge Lin123,Shi Huifeng123,Wang Xiaoxia123,Li Luyao12,Qiao Jie123,Zhao Yangyu123,Qi Hongbo5,Ma Xudong6,Wei Yuan123

Affiliation:

1. Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China

2. National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China

3. National Centre for Healthcare Quality Management in Obstetrics, Beijing, China

4. Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Centre, Beijing, China

5. Department of Obstetrics, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China

6. Department of Healthcare Quality Evaluation, Bureau of Medical Administration, National Health Commission of the People’s Republic of China, Beijing, China

Abstract

ImportanceSubstantial regional variation in cesarean delivery rates has been reported in China, but there is a lack of reports on hospital-level variation in these rates among low-risk deliveries.ObjectivesTo evaluate hospital variation in cesarean rates in China for term, singleton, live vertex deliveries among women with no prior cesarean delivery and to estimate contributions of individual and hospital factors.Design, Setting, and ParticipantsThis nationwide cross-sectional study used data from maternal patient discharge records collected by the Hospital Quality Monitoring System in China from January 1 to December 31, 2020. Pregnant female individuals aged 15 to 49 years (referred to hereafter as women) with at least 1 live birth were included, and low-risk deliveries were defined as term, singleton, live, vertex deliveries with no prior cesarean delivery.ExposuresBirth by cesarean delivery.Main Outcomes and MeasuresThe main outcome was cesarean delivery rate by hospital. Hierarchical logistic regression analysis was used to calculate the adjusted cesarean rate and to estimate the percentage of hospital variation in low-risk deliveries explained by individual and hospital factors.ResultsAmong the 7 635 149 deliveries identified from 4359 hospitals in 31 provinces of mainland China, 6 599 468 (86.4%) were considered low risk. Of overall and low-risk deliveries, 3 400 162 and 2 638 097 were cesarean deliveries, corresponding to mean rates of 44.5% and 40.0%, respectively. The mean (SD) maternal age for overall and low-risk deliveries was 29.1 (4.0) and 28.8 (4.8) years, respectively, and mothers were more likely to be of Han ethnicity (89.5%). Cesarean rates varied widely among hospitals, with absolute differences between the 5th and 95th percentiles of 53.5% (19.4%-72.9%) for overall deliveries and 56.8% (14.3%-71.1%) for low-risk deliveries. Large absolute differences remained after adjusting for maternal characteristics, with rates of 47.4% (19.1%-66.5%) for overall deliveries and 52.6% (15.0%-67.6%) for low-risk deliveries. Among low-risk deliveries, hospital factors (eg, hospital province location) explained 31.3% of the hospital variation in cesarean rate and individual factors explained an additional 2.0%.Conclusions and RelevanceThe findings of this cross-sectional study suggest that cesarean rates varied markedly among hospitals in China in 2020, which may be attributable to hospital rather than individual factors. Future work is needed to design hospital-level initiatives to optimize cesarean use, particularly among low-risk deliveries.

Publisher

American Medical Association (AMA)

Subject

General Medicine

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