{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:29:08Z","timestamp":1787729348396,"version":"build-2784847793"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:p>\n            Objective\u2003This study aimed to assess whether racial disparities in nulliparous, term, singleton, vertex cesarean delivery rates vary among hospitals of different type (academic vs. nonacademic), setting (urban vs. rural), delivery volume, and patient population.<\/jats:p><jats:p>\n            Study Design\u2003This is a retrospective cohort study including singleton term vertex live births in nulliparous Black and non-Hispanic White birthing people in California between 2011 and 2017. Cesarean delivery rates were obtained using birth certificate data and International Classification of Diseases, 9th\/10th Revision codes. Risk of cesarean delivery was compared among Black versus White birthing people by hospital type (academic, nonacademic), setting (rural, suburban, urban), volume (&lt; 1,200, 1,200\u20132,300, 2,400\u20133,599, \u22653,600 deliveries annually), and patient population (proportion Black-serving). Federal Information Processing codes were used to designate hospital setting. Risks were calculated using univariable and multivariable logistic regression and adjusted for birthing person age, body mass index, medical comorbidities, gestational age, labor type (spontaneous vs. induction), and infant birthweight.<\/jats:p><jats:p>\n            Results\u2003The sample included 59,441 Black (cesarean delivery rate: 30.2%) and 363,624 White birthing people (cesarean delivery rate: 26.1%). Black birthing people were significantly more likely than White birthing people to have a cesarean delivery across nearly all hospital-level factors considered with adjusted relative risks ranging from 1.1 to 1.3. The only exception was rural settings in which the adjusted relative risk was 1.3 but did not reach statistical significance.<\/jats:p><jats:p>\n            Conclusion\u2003Black\u2013White disparities in nulliparous, term, singleton, vertex cesarean delivery rates were persistent across all hospital-level factors we considered: academic status, rurality, delivery volume, and patient population. Furthermore, disparities existed at roughly the same magnitude regardless of hospital characteristics. These global increased risks likely reflect structural inequities in care, which contribute to disparities in pregnancy-related morbidity and mortality. These data should encourage providers, hospital systems, and quality collaboratives to further investigate racial disparities in cesarean delivery rates and develop strategies for eliminating them.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0043-1776346","type":"journal-article","created":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T23:39:59Z","timestamp":1698881999000},"page":"375-382","source":"Crossref","is-referenced-by-count":9,"title":["Racial Disparities in Cesarean Delivery Rates: Do Hospital-Level Factors Matter?"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0786-4605","authenticated-orcid":false,"given":"E.","family":"Nicole Teal","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca J.","family":"Baer","sequence":"additional","affiliation":[{"name":"California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Jelliffe-Pawlowski","sequence":"additional","affiliation":[{"name":"California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California"},{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biftu","family":"Mengesha","sequence":"additional","affiliation":[{"name":"California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,11,1]]},"reference":[{"key":"ref1","volume-title":"Vital statistics data available online: natality public-use file and CD\u2013ROM","author":"National Center for Health Statistics","year":"2018"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1503\/cmaj.060870","article-title":"Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term","volume":"176","author":"S Liu","year":"2007","journal-title":"CMAJ"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.1097\/AOG.0000000000000735","article-title":"Racial and ethnic disparities in maternal morbidity and obstetric care","volume":"125","author":"W A Grobman","year":"2015","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1213\/ANE.0b013e3182691e62","article-title":"The association of maternal race and ethnicity and the risk of postpartum hemorrhage","volume":"115","author":"A Bryant","year":"2012","journal-title":"Anesth Analg"},{"issue":"01","key":"ref6","first-page":"69","article-title":"Factors associated with postpartum hemorrhage with vaginal birth","volume":"77","author":"C A Combs","year":"1991","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.whi.2005.12.004","article-title":"Obstetric complications during labor and delivery: assessing ethnic differences in California","volume":"16","author":"S Guendelman","year":"2006","journal-title":"Womens Health Issues"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.1177\/0022146510383838","article-title":"Understanding racial-ethnic disparities in health: sociological contributions","volume":"51","author":"D R Williams","year":"2010","journal-title":"J Health Soc Behav"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1089\/jwh.2020.8606","article-title":"Severe maternal morbidity, race, and rurality: trends using the national inpatient sample, 2012-2017","volume":"30","author":"A A Luke","year":"2021","journal-title":"J Womens Health (Larchmt)"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1097\/01.sla.0000197560.92456.32","article-title":"Race and surgical mortality in the United States","volume":"243","author":"F L Lucas","year":"2006","journal-title":"Ann Surg"},{"issue":"17","key":"ref11","doi-asserted-by":"crossref","first-page":"2634","DOI":"10.1161\/CIRCULATIONAHA.105.543231","article-title":"Mortality after acute myocardial infarction in hospitals that disproportionately treat black patients","volume":"112","author":"J Skinner","year":"2005","journal-title":"Circulation"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"e407","DOI":"10.1542\/peds.2007-0910","article-title":"Black\/white differences in very low birth weight neonatal mortality rates among New York City hospitals","volume":"121","author":"E A Howell","year":"2008","journal-title":"Pediatrics"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"122.e1","DOI":"10.1016\/j.ajog.2015.08.019","article-title":"Black-White differences in severe maternal morbidity and site of care","volume":"214","author":"E A Howell","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref14","doi-asserted-by":"crossref","first-page":"647.e1","DOI":"10.1016\/j.ajog.2014.06.006","article-title":"Performance of racial and ethnic minority-serving hospitals on delivery-related indicators","volume":"211","author":"A A Creanga","year":"2014","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1097\/AOG.0000000000004139","article-title":"Hospital-level variation in the frequency of cesarean delivery among nulliparous women who undergo labor induction","volume":"136","author":"E K Main","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"123.e1","DOI":"10.1016\/j.ajog.2015.08.027","article-title":"Hospital variation in cesarean delivery rates: contribution of individual and hospital factors in Florida","volume":"214","author":"Y V Sebasti\u00e3o","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1007\/s40615-020-00889-2","article-title":"Risk and protective factors for preterm birth among Black women in Oakland, California","volume":"8","author":"M R McLemore","year":"2020","journal-title":"J Racial Ethn Health Disparities"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1186\/s12884-020-03290-3","article-title":"Preterm birth and nativity among Black women with gestational diabetes in California, 2013-2017: a population-based retrospective cohort study","volume":"20","author":"K A Scott","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"issue":"02","key":"ref19","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.soard.2020.09.016","article-title":"Pregnancy after bariatric surgery in women with rheumatic diseases and association with adverse birth outcomes","volume":"17","author":"N Singh","year":"2021","journal-title":"Surg Obes Relat Dis"},{"issue":"05","key":"ref20","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1542\/peds.2013-3285","article-title":"United States birth weight reference corrected for implausible gestational age estimates","volume":"133","author":"N M Talge","year":"2014","journal-title":"Pediatrics"},{"issue":"04","key":"ref23","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1097\/AOG.0000000000001628","article-title":"Health care disparity and state-specific pregnancy-related mortality in the United States, 2005-2014","volume":"128","author":"A Moaddab","year":"2016","journal-title":"Obstet Gynecol"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.annepidem.2019.02.007","article-title":"Racial and ethnic disparities in severe maternal morbidity prevalence and trends","volume":"33","author":"S A Leonard","year":"2019","journal-title":"Ann Epidemiol"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1186\/1471-2393-13-168","article-title":"Racial and ethnic differences in primary, unscheduled cesarean deliveries among low-risk primiparous women at an academic medical center: a retrospective cohort study","volume":"13","author":"J K Edmonds","year":"2013","journal-title":"BMC Pregnancy Childbirth"},{"issue":"05","key":"ref26","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/j.ajog.2005.11.043","article-title":"Intrinsic racial differences in the risk of cesarean delivery are not explained by differences in caregivers or hospital site of delivery","volume":"194","author":"J H Chung","year":"2006","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref29","doi-asserted-by":"crossref","first-page":"478.e1","DOI":"10.1016\/j.ajog.2012.09.029","article-title":"The association between hospital obstetric volume and perinatal outcomes in California","volume":"207","author":"J M Snowden","year":"2012","journal-title":"Am J Obstet Gynecol"},{"issue":"11","key":"ref30","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1001\/archinte.167.11.1177","article-title":"Concentration and quality of hospitals that care for elderly black patients","volume":"167","author":"A K Jha","year":"2007","journal-title":"Arch Intern Med"},{"issue":"01","key":"ref31","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/j.1475-6773.2012.01445.x","article-title":"Outcomes for whites and blacks at hospitals that disproportionately care for black Medicare beneficiaries","volume":"48","author":"L L\u00f3pez","year":"2013","journal-title":"Health Serv Res"},{"issue":"06","key":"ref32","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1097\/AOG.0000000000002343","article-title":"Racial and ethnic differences in utilization of labor management strategies intended to reduce cesarean delivery rates","volume":"130","author":"L M Yee","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref33","first-page":"842","article-title":"Racial and ethnic disparities in primary cesarean birth and adverse outcomes among low-risk nulliparous people","volume":"140","author":"M Fishel Bartal","year":"2022","journal-title":"Obstet Gynecol"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.annepidem.2022.06.003","article-title":"Variation and racial\/ethnic disparities in cesarean delivery at New York City hospitals: the contribution of hospital-level factors","volume":"73","author":"E Brazier","year":"2022","journal-title":"Ann Epidemiol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1776346.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T17:06:02Z","timestamp":1730826362000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1776346"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,1]]},"references-count":29,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2024,2,21]]},"published-print":{"date-parts":[[2024,3]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1776346","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,1]]}}}