{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T04:10:18Z","timestamp":1776399018617,"version":"3.51.2"},"reference-count":34,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T00:00:00Z","timestamp":1695945600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Institute for Asian American Studies, Boston MA, United States"},{"name":"Sigma Theta Tau International Theta Alpha Chapter"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>This study examined the health disparities in primary cesarean delivery (PCD) use among Asian American (AA) women and within AA subgroups. We examined 22 years of birth registry data from one diverse northeastern state in the United States, including singleton vertex live births between 24 and 44 weeks of gestation without congenital abnormalities. Multivariate logistic regression was used to test the association between PCD and race and ethnicity groups adjusting for maternal demographic and health behaviors, infant gender and birth weight, gestational age, initiation of prenatal care, and other risk factors. Among the eligible sample, 8.3% were AA. AAs had the highest rate of PCD (18%) among all racial and ethnic groups. However, extensive heterogeneity was found among the AA subgroups. After controlling for confounding variables, compared to non-Hispanic White women, Filipino, Asian Indian, and Other Asian subgroups had a higher risk for PCD (Adj OR = 1.40, 1.37, and 1.21, p &lt; 0.001), while Japanese, Chinese, and Korean had a lower risk (Adj OR = 0.57, 0.83, and 0.90, p &lt; 0.001), and Vietnamese had no significant difference in PCD use. Although AA as a single racial and ethnic group had higher prevalence of PCD, more studies are warrantied to address the disproportional distribution of health disparities in PCD use within AA subgroups.<\/jats:p>","DOI":"10.3390\/ijerph20196860","type":"journal-article","created":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T07:42:08Z","timestamp":1695973328000},"page":"6860","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Health Disparities in the Use of Primary Cesarean Delivery among Asian American Women"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7218-7201","authenticated-orcid":false,"given":"Yuqing","family":"Zhang","sequence":"first","affiliation":[{"name":"College of Nursing, University of Cincinnati, Cincinnati, OH 45040, USA"},{"name":"Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Heelan-Fancher","sequence":"additional","affiliation":[{"name":"Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0427-1580","authenticated-orcid":false,"given":"Suzanne","family":"Leveille","sequence":"additional","affiliation":[{"name":"Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling","family":"Shi","sequence":"additional","affiliation":[{"name":"Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,29]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Births: Final data for 2020","volume":"70","author":"Osterman","year":"2022","journal-title":"Natl. Vital Stat. Rep."},{"key":"ref_2","unstructured":"World Health Organization (2023, May 06). WHO Statement on Caesarean Section Rates. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/161442\/WHO_RHR_15.02_eng.pdf?sequence=1."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12978-015-0043-6","article-title":"What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies","volume":"12","author":"Betran","year":"2015","journal-title":"Reprod. Health"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Betr\u00e1n, A.P., Ye, J., Moller, A.-B., Zhang, J., G\u00fclmezoglu, A.M., and Torloni, M.R. (2016). The increasing trend in caesarean section rates: Global, regional and national estimates: 1990\u20132014. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0148343"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"American College of Obstetrics & Gynecology, and Society of Maternal-Fetal Medicine (2014). Safe prevention of the primary cesarean delivery. Am. J. Obstet. Gynecol., 210, 179\u2013193.","DOI":"10.1016\/j.ajog.2014.01.026"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.3945\/ajcn.111.030254","article-title":"Breastfeeding after cesarean delivery: A systematic review and meta-analysis of world literature","volume":"95","author":"Prior","year":"2012","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Negrini, R., da Silva Ferreira, R.D., and Guimar\u00e3es, D.Z. (2021). Value-based care in obstetrics: Comparison between vaginal birth and caesarean section. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-03798-2"},{"key":"ref_8","unstructured":"Budiman, A., and Ruiz, N.G. (2023, August 31). Key Facts about Asian Americans, a Diverse and Growing Population. Available online: https:\/\/www.pewresearch.org\/short-reads\/2021\/04\/29\/key-facts-about-asian-americans\/."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"435","DOI":"10.2105\/AJPH.2020.305596","article-title":"Taking action to improve Asian American health","volume":"110","author":"Yi","year":"2020","journal-title":"Am. J. Public Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2248","DOI":"10.1007\/s40615-021-01164-8","article-title":"Advancing Health Disparities Research: The Need to Include Asian American Subgroup Populations","volume":"9","author":"Yom","year":"2022","journal-title":"J. Racial Ethn. Health Disparities"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1525\/sp.2012.59.2.207","article-title":"Unequal motherhood: Racial-ethnic and socioeconomic disparities in cesarean sections in the United States","volume":"59","author":"Roth","year":"2012","journal-title":"Soc. Probl."},{"key":"ref_12","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":"Edmonds","year":"2013","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Williams, A., Little, S.E., Bryant, A.S., and Smith, N.A. (2022). Mode of delivery and unplanned cesarean: Differences in rates and indication by race, ethnicity, and sociodemographic characteristics. Am. J. Perinatol., Online ahead of print.","DOI":"10.1055\/a-1785-8843"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1111\/birt.12108","article-title":"The Influence of detailed maternal ethnicity on cesarean delivery: Findings from the U.S. birth certificate in the State of Massachusetts","volume":"41","author":"Edmonds","year":"2014","journal-title":"Birth"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Carlson, N.S., Carlson, M.S., Erickson, E.N., Higgins, M., Britt, A.J., and Amore, A.D. (2023). Disparities by race\/ethnicity in unplanned cesarean birth among healthy nulliparas: A secondary analysis of the nuMoM2b dataset. BMC Pregnancy Childbirth, 23.","DOI":"10.1186\/s12884-023-05667-6"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"422.e1","DOI":"10.1016\/j.ajog.2009.07.062","article-title":"Racial and ethnic disparities in the trends in primary cesarean delivery based on indications","volume":"201","author":"Getahun","year":"2009","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Hanson, C., Samson, K., Anderson-Berry, A.L., Slotkowski, R.A., and Su, D. (2022). Racial disparities in caesarean delivery among nulliparous women that delivered at term: Cross-sectional decomposition analysis of Nebraska birth records from 2005\u20132014. BMC Pregnancy Childbirth, 22.","DOI":"10.1186\/s12884-022-04666-3"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1097\/AOG.0000000000004953","article-title":"Racial and Ethnic Disparities in Primary Cesarean Birth and Adverse Outcomes Among Low-Risk Nulliparous People","volume":"140","author":"Chen","year":"2022","journal-title":"Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1007\/s40615-020-00842-3","article-title":"Examining Cesarean Delivery Rates by Race: A Population-Based Analysis Using the Robson Ten-Group Classification System","volume":"8","author":"Valdes","year":"2021","journal-title":"J. Racial Ethn. Health Disparities"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1111\/1475-6773.14122","article-title":"Inequalities in cesarean births between American Indian & Alaska Native people and White people","volume":"58","author":"Gartner","year":"2023","journal-title":"Health Serv. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/birt.12422","article-title":"Impact of continuous electronic fetal monitoring on birth outcomes in low-risk pregnancies","volume":"46","author":"Shi","year":"2019","journal-title":"Birth"},{"key":"ref_22","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":"Brazier","year":"2022","journal-title":"Ann. Epidemiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1007\/s40615-021-01057-w","article-title":"Racial and ethnic disparities in cesarean delivery and Indications among nulliparous, term, singleton, vertex women","volume":"9","author":"Okwandu","year":"2022","journal-title":"J. Racial Ethn. Health Disparities"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"520","DOI":"10.2105\/AJPH.2019.305523","article-title":"Health conditions, outcomes, and service access among filipino, vietnamese, Chinese, Japanese, and Korean adults in California, 2011\u20132017","volume":"110","author":"Adia","year":"2020","journal-title":"Am. J. Public Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"462","DOI":"10.2105\/AJPH.2019.305552","article-title":"Maternal mortality: A US public health crisis","volume":"110","author":"Gingrey","year":"2020","journal-title":"Am. J. Public Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"814.e1","DOI":"10.1016\/j.ajog.2015.01.029","article-title":"Investigating racial differences in risk factors for primary cesarean delivery","volume":"212","author":"Min","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_27","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":"Yee","year":"2017","journal-title":"Obstet. Gynecol."},{"key":"ref_28","unstructured":"(2023, August 31). Office of Minority Health, Profile: Asian Americans, Available online: https:\/\/www.minorityhealth.hhs.gov\/omh\/browse.aspx?lvl=3&lvlid=63."},{"key":"ref_29","unstructured":"Centers for Disease Control and Prevention (2023, August 31). Number and Rate of Hepatitis B-Related Deaths, by Demographic Characteristics and Year, United States, 2012\u20132016. National Vital Statistics System, Table 3.5, Available online: https:\/\/www.cdc.gov\/hepatitis\/statistics\/2016surveillance\/index.htm#tabs-2-5."},{"key":"ref_30","unstructured":"(2023, August 31). United States Department of Health and Human Services Office of Minority Health Infant Mortality and Asian Americans, Available online: https:\/\/minorityhealth.hhs.gov\/omh\/browse.aspx?lvl=4&lvlid=53."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/s10900-018-0577-y","article-title":"Birth certificate validity and the impact on primary cesarean section quality measure in New York State","volume":"44","author":"Josberger","year":"2019","journal-title":"J. Community Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/ppe.12326","article-title":"Evaluation of the sensitivity and accuracy of birth defects indicators on the 2003 Revision of the U.S. Birth Certificate: Has data quality improved?","volume":"31","author":"Salemi","year":"2017","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/ajo.12628","article-title":"Comparison of adverse pregnancy outcomes based on the new IADPSG 2010 gestational diabetes criteria and maternal body mass index","volume":"57","author":"Jiang","year":"2017","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"413","DOI":"10.12968\/bjom.2019.27.7.413","article-title":"Diabetes in pregnancy: A practical guide for midwives","volume":"27","author":"Surendran","year":"2019","journal-title":"Br. J. Midwifery"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/19\/6860\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:01:33Z","timestamp":1760130093000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/19\/6860"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,29]]},"references-count":34,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["ijerph20196860"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20196860","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,29]]}}}