ArticleJournal of racial and ethnic health disparities2026
Can Birth Hospital Explain Racial/Ethnic Differences in Cesarean Birth Among Low-Risk Births? An Analysis of California Data, 2007-2018.
Article in Journal of racial and ethnic health disparities, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn the US, there is substantial variability in low-risk cesarean birth rate by hospitals and race/ethnicity. The contribution of inequitable hospital quality to disparities in low-risk cesarean births is uncertain. We examine the contribution of birth hospital to racial/ethnic disparities in low-risk cesarean births.
methodsWe used vital records linked with maternal birth hospitalization data (California, 2007-18). We examined self-reported race/ethnicity and low-risk cesarean birth, i.e., nulliparous, term, singleton, and vertex (NTSV) births. Poisson regression models with a mixed effect for hospital and bootstrapped errors were used to compare racial/ethnic differences in cesarean prevalence, adjusted for maternal and hospital characteristics. We used G-computation to assess how the prevalence of cesarean section by racial/ethnic group would change if all births occurred at the same distribution of hospitals as births to White individuals.
resultsAmong 1,594,277 NTSV births at 212 hospitals, 26.9% were cesarean. After adjustment for hospital characteristics, risk ratios for cesarean birth ranged from 1.05 for foreign-born Hispanic (95% CI 1.02-1.09) to 1.28 for Black (95% CI 1.22-1.33) individuals, relative to White individuals. In the G-computation substitution, cesarean prevalence among NTSV births was reduced for some race/ethnicities and increased for others, ranging from 87 excess events (0.3% increase) in Black populations to 6473 avoided events (5.6% decrease) among US-born Hispanic populations.
conclusionsRacial/ethnic disparities in cesarean prevalence among low-risk births in California are not explained by individual-level maternal or hospital characteristics.
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