{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T12:39:32Z","timestamp":1775911172686,"version":"3.50.1"},"reference-count":48,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,11,2]],"date-time":"2017-11-02T00:00:00Z","timestamp":1509580800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"JSPS Fellows","award":["26-1591"],"award-info":[{"award-number":["26-1591"]}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science: KAKENHI","doi-asserted-by":"crossref","award":["16H06647"],"award-info":[{"award-number":["16H06647"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>High cesarean section (CS) rates in middle and high\u2010income countries are partly attributable to provider factors, such as staffing patterns and fear of litigation. However, the relationship between CS rates and healthcare resources in the community is poorly understood. Official data on CS rates has been particularly limited in Japan. In this study, we examined nationwide CS statistics and evaluated the association with local resources for perinatal care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used accumulated data for CS registered in the Japan National Database of health insurance claims in 2013 and calculated crude and age\u2010standardized CS rates at national and prefectural levels. We analyzed the ecological associations with supply of obstetricians and institution and scale of obstetric facilities using multiple regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 190\u2009361 cesarean deliveries in 2013, giving an overall CS rate of 18.5% (elective CS rates 11.0%), which varied by prefecture from 14.0% to 25.6%. In multiple regression analyses, the areal number of obstetricians (standardized regression coefficient [\u03b2]\u2009=\u2009\u22120.58), the proportion of births at small\u2010scale institutions (\u03b2\u2009=\u20090.36) and the number of beds at neonatal intensive care units per birth (\u03b2\u2009=\u2009\u22120.20) were significantly associated with the age\u2010standardized elective CS rate after adjusting for socioeconomic factors (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> for the model\u2009=\u20090.40).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Higher elective CS rates might be associated with limited or unconsolidated medical resources. Policymakers should be aware of regional differences and the possible effects of perinatal care resources on CS rates.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jog.13518","type":"journal-article","created":{"date-parts":[[2017,11,2]],"date-time":"2017-11-02T08:03:53Z","timestamp":1509609833000},"page":"208-216","source":"Crossref","is-referenced-by-count":45,"title":["Cesarean section rates and local resources for perinatal care in Japan: A nationwide ecological study using the national database of health insurance claims"],"prefix":"10.1111","volume":"44","author":[{"given":"Eri","family":"Maeda","sequence":"first","affiliation":[{"name":"Department of Environmental Health Sciences Akita University Graduate School of Medicine  Akita Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osamu","family":"Ishihara","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Saitama Medical University  Saitama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Tomio","sequence":"additional","affiliation":[{"name":"Department of Public Health, Graduate School of Medicine The University of Tokyo  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aya","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences Akita University Graduate School of Medicine  Akita Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukihiro","family":"Terada","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Akita University Graduate School of Medicine  Akita Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuki","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Public Health, Graduate School of Medicine The University of Tokyo  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsuyuki","family":"Murata","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences Akita University Graduate School of Medicine  Akita Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,11,2]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"Health at a Glance 2015: OECD Indicators","author":"Organisation for Economic Co\u2010operation and Development","year":"2015"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0148343"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.18663"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-015-0043-6"},{"key":"e_1_2_8_6_1","first-page":"CD001998","article-title":"Interventions for suspected placenta praevia","author":"Neilson JP","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rhm.2015.07.007"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01295.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12311"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2010.02793.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2012.11.011"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)03169-X"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200106000-00003"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckp184"},{"key":"e_1_2_8_15_1","volume-title":"Survey of Medical Institutions","author":"Ministry of Health, Labour and Welfare","year":"2014"},{"key":"e_1_2_8_16_1","first-page":"1281","article-title":"Survey of obstetricians\/gynecologists practicing at clinical facilities in Japan","volume":"50","author":"Nakai A","year":"2015","journal-title":"Nihon Shusanki Shinseiji Igakukai Zasshi"},{"key":"e_1_2_8_17_1","first-page":"39","article-title":"Challenges faced by Japan's perinatal care service system: With focuses on the disparity between different medical districts and the intensity of medical resources","volume":"9","author":"Ishikawa M","year":"2015","journal-title":"Nihon Iryo Keiei Gakkaishi"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2012.04.026"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/0167-6296(95)00039-9"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31823904d0"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.133"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0148122"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-6296(99)00004-1"},{"key":"e_1_2_8_24_1","unstructured":"Ministry of Health Labour and Welfare. [Website for the Japan National database of health insurance claims.] (In Japanese.) [Cited 20 Dec 2016]. Available from URL:http:\/\/www.mhlw.go.jp\/stf\/seisakunitsuite\/bunya\/kenkou_iryou\/iryouhoken\/reseputo\/"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60828-3"},{"key":"e_1_2_8_26_1","unstructured":"Ministry of Health Labour and Welfare. [Survey on welfare recipients.]2013. (In Japanese.) [Cited 20 Dec 2016]. Available from URL:https:\/\/www.e\u2010stat.go.jp\/SG1\/estat\/GL08020101.do?_toGL08020101_&tstatCode=000001070700"},{"key":"e_1_2_8_27_1","unstructured":"Health Insurance Claims Review & Reimbursement Services. [Tables of medical and dental fees.] (In Japanese.) [Cited 20 Dec 2016]. Available from URL:http:\/\/www.ssk.or.jp\/seikyushiharai\/tensuhyo\/ikashika\/index.html"},{"key":"e_1_2_8_28_1","unstructured":"Ministry of Health Labour and Welfare. [Guideline for the improvement project for perinatal care systems.] 2010. (In Japanese.) [Cited 20 Dec 2016]. Available from URL:http:\/\/www.mhlw.go.jp\/file\/05-Shingikai-10801000-Iseikyoku-Soumuka\/0000096051.pdf"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-120"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0156621"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/med\/9780195377903.001.0001"},{"key":"e_1_2_8_32_1","first-page":"423","article-title":"\"Satogaeri childbirth\" and actual lifestyles during the perinatal period","volume":"45","author":"Ohga A","year":"2005","journal-title":"Bosei Eisei"},{"key":"e_1_2_8_33_1","volume-title":"Medical Statistics for Evidence Based Medicine with SPBS User's Guide","author":"Murata K","year":"2002"},{"key":"e_1_2_8_34_1","first-page":"436","article-title":"Appropriate technology for birth","volume":"2","author":"World Health Organisation","year":"1985","journal-title":"Lancet"},{"key":"e_1_2_8_35_1","volume-title":"The Guideline for Obstetric and Gynecological Care","author":"Japan Society for Obstetrics and Gynecology","year":"2014"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/cku224"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.15553"},{"key":"e_1_2_8_38_1","unstructured":"Ministry of Health Labour and Welfare. [Vital statistics.] (In Japanese.) [Cited 20 Dec 2016]. Available from URL:http:\/\/www.e\u2010stat.go.jp\/SG1\/estat\/NewList.do?tid=000001028897"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2013.860440"},{"key":"e_1_2_8_40_1","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1111\/birt.12231","article-title":"Survey of obstetric care and cesarean delivery rates in Shanghai, China","volume":"43","author":"Hellerstein S","year":"2016","journal-title":"Birth"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.06.040"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.05.051"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0156172"},{"key":"e_1_2_8_44_1","unstructured":"Ministry of Health Labour and Welfare. [Report for welfare.]2013. (In Japanese.) [Cited 20 Dec 2016]. Available from URL:http:\/\/www.mhlw.go.jp\/toukei\/list\/38-1.html"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13278"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13304"},{"key":"e_1_2_8_47_1","volume-title":"Designing Clinical Research","author":"Hulley SB","year":"2013"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00501.x"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/del522"}],"container-title":["Journal of Obstetrics and Gynaecology Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjog.13518","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jog.13518","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T01:23:32Z","timestamp":1695777812000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/jog.13518"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,2]]},"references-count":48,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2018,2]]}},"alternative-id":["10.1111\/jog.13518"],"URL":"https:\/\/doi.org\/10.1111\/jog.13518","archive":["Portico"],"relation":{},"ISSN":["1341-8076","1447-0756"],"issn-type":[{"value":"1341-8076","type":"print"},{"value":"1447-0756","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,2]]}}}