TY - JOUR
T1 - Primary Cesarean Delivery Patterns among Women with Physical, Sensory, or Intellectual Disabilities
AU - Darney, Blair G.
AU - Biel, Frances M.
AU - Quigley, Brian P.
AU - Caughey, Aaron B.
AU - Horner-Johnson, Willi
N1 - Funding Information:
Funding: Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award #R21HD081309 (Horner-Johnson, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Support for Dr. Horner-Johnson's time was provided by grant #K12HS022981 from the Agency for Healthcare Research and Quality (AHRQ) (Guise, PI). Dr. Darney is partially supported by a Junior Investigator Award from the Society of Family Planning. The funding agencies had no role in the conduct of the research or preparation of the manuscript for submission. The authors report no conflicts of interest.
Publisher Copyright:
© 2017 Jacobs Institute of Women's Health
PY - 2017/5
Y1 - 2017/5
N2 - Background Little is known about the relationship between disability and mode of delivery. Prior research has indicated elevated risk of cesarean delivery among women with certain disabilities, but has not examined patterns across multiple types of disability or by parity. Objective This study sought to determine whether physical, sensory, or intellectual and developmental disabilities are independently associated with primary cesarean delivery. Methods We conducted a retrospective cohort study of all deliveries in California from 2000 to 2010 using linked birth certificate and hospital discharge data. We identified physical, sensory, and intellectual and developmental disabilities using International Classification of Diseases, 9th revision, clinical modification codes. We used logistic regression to examine the association of these disabilities and primary cesarean delivery, controlling for sociodemographic characteristics and comorbidities, and stratified by parity. Results In our sample, 0.45% of deliveries (20,894/4,610,955) were to women with disabilities. A greater proportion of women with disabilities were nulliparous, had public insurance, and had comorbidities (e.g., gestational diabetes) compared with women without disabilities (p < .001 for all). The proportion of primary cesarean in women with disabilities was twice that in women without disabilities (32.7% vs. 16.3%; p < .001; adjusted odds ratio, 2.05; 95% confidence interval, 1.94–2.17). The proportion of deliveries by cesarean was highest among women with physical disabilities due to injuries compared with women without disabilities (57.8% vs. 16.3%; p < .001; adjusted odds ratio, 6.83; 95% confidence interval, 5.46–8.53). Conclusions Women across disability subgroups have higher odds of cesarean delivery, and there is heterogeneity by disability type. More attention is needed to this population to ensure better understanding of care practices that may impact maternal and perinatal outcomes.
AB - Background Little is known about the relationship between disability and mode of delivery. Prior research has indicated elevated risk of cesarean delivery among women with certain disabilities, but has not examined patterns across multiple types of disability or by parity. Objective This study sought to determine whether physical, sensory, or intellectual and developmental disabilities are independently associated with primary cesarean delivery. Methods We conducted a retrospective cohort study of all deliveries in California from 2000 to 2010 using linked birth certificate and hospital discharge data. We identified physical, sensory, and intellectual and developmental disabilities using International Classification of Diseases, 9th revision, clinical modification codes. We used logistic regression to examine the association of these disabilities and primary cesarean delivery, controlling for sociodemographic characteristics and comorbidities, and stratified by parity. Results In our sample, 0.45% of deliveries (20,894/4,610,955) were to women with disabilities. A greater proportion of women with disabilities were nulliparous, had public insurance, and had comorbidities (e.g., gestational diabetes) compared with women without disabilities (p < .001 for all). The proportion of primary cesarean in women with disabilities was twice that in women without disabilities (32.7% vs. 16.3%; p < .001; adjusted odds ratio, 2.05; 95% confidence interval, 1.94–2.17). The proportion of deliveries by cesarean was highest among women with physical disabilities due to injuries compared with women without disabilities (57.8% vs. 16.3%; p < .001; adjusted odds ratio, 6.83; 95% confidence interval, 5.46–8.53). Conclusions Women across disability subgroups have higher odds of cesarean delivery, and there is heterogeneity by disability type. More attention is needed to this population to ensure better understanding of care practices that may impact maternal and perinatal outcomes.
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U2 - 10.1016/j.whi.2016.12.007
DO - 10.1016/j.whi.2016.12.007
M3 - Article
C2 - 28109562
AN - SCOPUS:85009761395
VL - 27
SP - 336
EP - 344
JO - Women's Health Issues
JF - Women's Health Issues
SN - 1049-3867
IS - 3
ER -