Examining Racial and Ethnic Disparities in Low-Risk Cesarean Section Deliveries in the Colorado Healthy Start Study.

BACKGROUND

Cesarean sections (CS) create unnecessary health risks for mothers and newborns in low-risk contexts. In the United States, low-risk CS prevalence is higher among people of color, though this may vary across regions. We investigated low-risk CS prevalence by race and ethnicity in a Colorado pregnancy cohort comprising primarily Hispanic and non-Hispanic White mother-offspring pairs.

METHODS

Pregnant women in Denver, Colorado were enrolled (2009-2014, n = 1,410). 904 mother-offspring pairs met the criteria for low-risk birth and were included in this analysis. Low-risk CS was based on (1) Society for Maternal-Fetal Medicine criteria and (2) nulliparous, term, singleton, vertex (NTSV) criteria. Demographic and clinical characteristics were self-reported or extracted from medical records and included in statistical models as potential confounders. Poisson regression assessed relative risk of delivering via low-risk CS by race and ethnicity independent of demographic and clinical characteristics. A sensitivity analysis excluded non-nulliparous births.

RESULTS

Participants self-identified as non-Hispanic White (58%), Hispanic (26%), and non-Hispanic Black (16%). The prevalence of low-risk CS was 14-17% across racial and ethnic groups, with non-Hispanic Black individuals having the highest prevalence. After adjustment, no differences were observed in the likelihood of low-risk CS between non-Hispanic Black and non-Hispanic White women (RR = 0.99, 95% CI = 0.54 to 1.72) or between Hispanic and non-Hispanic White women (RR = 0.90, 95% CI = 0.52 to 1.53).

CONCLUSIONS

Disparities in low-risk CS documented in other settings were not observed in our sample. Further research should examine broader factors that may be protective against racial and ethnic disparities in Denver, across Colorado, and beyond.