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

作者全名："Yin, Shaohua; Chen, Lian; Zhou, Yubo; Yuan, Pengbo; Guo, Xiaoyue; Lu, Jie; Ge, Lin; Shi, Huifeng; Wang, Xiaoxia; Li, Luyao; Qiao, Jie; Zhao, Yangyu; Qi, Hongbo; Ma, Xudong; Wei, Yuan"

作者地址："[Yin, Shaohua; Chen, Lian; Yuan, Pengbo; Guo, Xiaoyue; Lu, Jie; Ge, Lin; Shi, Huifeng; Wang, Xiaoxia; Li, Luyao; Qiao, Jie; Zhao, Yangyu; Wei, Yuan] Peking Univ Third Hosp, Dept Obstet & Gynecol, Beijing, Peoples R China; [Yin, Shaohua; Chen, Lian; Yuan, Pengbo; Guo, Xiaoyue; Lu, Jie; Ge, Lin; Shi, Huifeng; Wang, Xiaoxia; Li, Luyao; Qiao, Jie; Zhao, Yangyu; Wei, Yuan] Natl Clin Res Ctr Obstet & Gynaecol, Beijing, Peoples R China; [Yin, Shaohua; Chen, Lian; Ge, Lin; Shi, Huifeng; Wang, Xiaoxia; Qiao, Jie; Zhao, Yangyu; Wei, Yuan] Natl Ctr Healthcare Qual Management Obstet, Beijing, Peoples R China; [Zhou, Yubo] Peking Univ, Inst Reprod & Child Hlth, Natl Hlth Commiss, Key Lab Reprod Hlth,Hlth Sci Ctr, Beijing, Peoples R China; [Qi, Hongbo] Chongqing Med Univ, Dept Obstet, Women & Childrens Hosp, Chongqing, Peoples R China; [Ma, Xudong] Natl Hlth Commiss Peoples Republ China, Dept Healthcare Qual Evaluat, Bur Med Adm, Beijing, Peoples R China"

通信作者："Wei, Y (通讯作者)，Peking Univ Third Hosp, Dept Obstet & Gynecol, Natl Clin Res Ctr Obstet & Gynaecol, Natl Ctr Healthcare Qual Management Obstet, 49 N Garden Rd, Beijing 100191, Peoples R China.; Ma, XD (通讯作者)，Natl Hlth Commiss Peoples Republ China, Bur Med Adm, Dept Healthcare Qual Evaluat, 1st Xizhimenwai South Rd, Beijing 100000, Peoples R China."

来源：JAMA NETWORK OPEN

ESI学科分类：　

WOS号：WOS:001047104900009

JCR分区：Q1

影响因子：10.5

年份：2023

卷号：6

期号：3

开始页：　

结束页：　

文献类型：Article

关键词：　

摘要："Key PointsQuestionDo cesarean delivery rates vary among hospitals in China? FindingsIn this cross-sectional study of more than 7.6 million deliveries from 4359 hospitals in China in 2020, the 5th and 95th percentiles of cesarean rates varied from 19% to 67% for overall deliveries and from 15% to 68% for term, singleton, live, vertex deliveries among women with no prior cesarean delivery. This large variation was likely driven by hospital factors, such as province location, rather than individual factors. MeaningThe results of this study suggest that cesarean delivery rates varied substantially among hospitals in China in 2020, reflecting inconsistent cesarean use and potential cesarean overuse even in low-risk deliveries. This cross-sectional study evaluates hospital variation in cesarean rates in China in 2020 for term, singleton, live, vertex deliveries among women with no prior cesarean delivery. 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 7635149 deliveries identified from 4359 hospitals in 31 provinces of mainland China, 6599468 (86.4%) were considered low risk. Of overall and low-risk deliveries, 3400162 and 2638097 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."

基金机构：Capital Funds for Health Improvement and Research [2020-1-4093]; Clinical Medicine Plus X-Young Scholars Project of Peking University [PKU2022LCXQ034]; Fundamental Research Funds for the Central Universities

基金资助正文：This study was supported by grant 2020-1-4093 from the Capital Funds for Health Improvement and Research and the Clinical Medicine Plus X-Young Scholars Project of Peking University and grant PKU2022LCXQ034 from the Fundamental Research Funds for the Central Universities.