Table 3.
Relative risk for the rate of hospital- and aggregated individual-level characteristics comparing hospitals NOT meeting the national NTSV cesarean birth rate target for Black gravidas to hospitals meeting the target*
| AAP NICU level | |||
|---|---|---|---|
|
| |||
| All Hospitals | Level I & II | Level III & IV | |
|
| |||
| Hospital-level factors and aggregated individual-level characteristics | aRR† (95% CI) | aRR† (95% CI) | aRR† (95% CI) |
| Hospital-level characteristics | |||
| >50% Medicaid in NTSV deliveries [yes vs no] | 1.30 (0.97, 1.73) | 2.21 (0.94, 5.21) | 1.24 (0.98, 1.57) |
| >20% of vaginal births attended by CNM [yes vs no] | 0.97 (0.72, 1.30) | 1.27 (0.53, 3.06) | 0.84 (0.64, 1.09) |
| Hospital Ownership [Public or Integrated Health System vs Private] | 1.03 (0.81, 1.32) | 1.43 (0.36, 5.78) | 1.08 (0.86, 1.35) |
| Average Annual Delivery Volume, 2018-2020 [ref= < 1,500] | |||
| 1,500-2,499 births | 1.23 (0.88, 1.73) | 0.96 (0.42, 2.22) | 1.33 (0.98, 1.81) |
| >=2500 births | 1.18 (0.86, 1.62) | 1.04 (0.44, 2.42) | 1.18 (0.88, 1.58) |
| AAP NICU level [Level III&IV vs Level I & II] | 1.56 (1.18, 2.05) | -- | -- |
| NTSV cesarean rate in White gravidas | 1.17 (1.06, 1.30) ‡ | 2.39 (1.47, 3.87) ‡ | 1.06 (0.97, 1.16)‡ |
| % of Black gravidas among all NTSV births | 1.00 (0.91, 1.10)‡ | 0.79 (0.53, 1.19)‡ | 1.03 (0.98, 1.10)‡ |
| 1.04 (0.96, 1.13)‡ | 1.13 (0.76, 1.69)‡ | 1.01 (0.95, 1.07)‡ | |
|
| |||
| Aggregated individual-level characteristics | |||
| % of Black NTSV gravidas age 35 and older | |||
| % of Black NTSV gravidas with pre-pregnancy BMI 30 and higher | 1.06 (0.97, 1.15)‡ | 1.01 (0.78, 1.30)‡ | 1.08 (1.00, 1.16)‡ |
| % of Black NTSV gravidas with high school or less education | 1.00 (0.95, 1.05)‡ | 1.09 (0.95, 1.26)‡ | 0.96 (0.92, 0.99)‡ |
| % of Black NTSV gravidas started prenatal care at the first trimester | 1.02 (0.97, 1.07)‡ | 1.01 (0.86, 1.18)‡ | 1.00 (0.95, 1.05)‡ |
| % of Black NTSV gravidas with preeclampsia or chronic hypertension | 1.00 (0.95, 1.05)‡ | 1.06 (0.76, 1.47)‡ | 1.00 (0.96, 1.03)‡ |
| % of Black NTSV gravidas with Preexisting or gestational diabetes | 0.96 (0.83, 1.10)‡ | 0.92 (0.45, 1.88)‡ | 1.02 (0.92, 1.14)‡ |
*
Analysis restricted to 135 hospitals with at least 30 NTSV births among both Black and white gravidas. Hospitals not meeting the target for Black gravidas were the outcome referent.
†
Adjusted RR and 95% CI estimated using robust poisson regression model including all the hospital-level factors and aggregated individual-level characteristics listed in the Table.
‡
Risk of cesarean relative to 5 percentage point increase for each characteristic