Table 3.
Patient, population, and market factors associated with cesarean section by payer
| Outcome = binary indicator of whether the birth was a cesarean section | All payer | Medicaid | Private | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Births = 2,516,570 | Births = 1,109,979 | Births = 1,271,296 | |||||||
| Independent variables | Odds ratio | 95% Confidence interval | Odds ratio | 95% Confidence interval | Odds ratio | 95% Confidence interval | |||
| Age (years) | |||||||||
| Reference Group 18-24 | |||||||||
| Under 18 | 0.998 | 0.981 | 1.016 | 1.046 | 1.024 | 1.069 | 0.875 | 0.843 | 0.909 |
| 25–29 | 0.891 | 0.883 | 0.900 | 0.794 | 0.783 | 0.805 | 1.007 | 0.993 | 1.021 |
| 30–34 | 0.876 | 0.868 | 0.885 | 0.821 | 0.807 | 0.836 | 0.954 | 0.941 | 0.967 |
| 35–39 | 1.006 | 0.994 | 1.018 | 0.984 | 0.961 | 1.008 | 1.079 | 1.062 | 1.096 |
| 40–44 | 1.317 | 1.288 | 1.345 | 1.236 | 1.184 | 1.291 | 1.438 | 1.401 | 1.475 |
| 45–64 | 2.085 | 1.936 | 2.247 | 1.650 | 1.414 | 1.927 | 2.392 | 2.190 | 2.612 |
| Payer | |||||||||
| Reference Group Private | |||||||||
| Medicaid | 0.773 | 0.767 | 0.779 | ||||||
| Other | 0.707 | 0.696 | 0.718 | ||||||
| Patient race | |||||||||
| Reference Group White | |||||||||
| Black | 1.113 | 1.100 | 1.126 | 1.062 | 1.045 | 1.079 | 1.176 | 1.155 | 1.197 |
| Hispanic | 0.850 | 0.841 | 0.858 | 0.780 | 0.768 | 0.793 | 0.965 | 0.950 | 0.980 |
| Asian | 0.994 | 0.979 | 1.010 | 0.908 | 0.878 | 0.938 | 1.045 | 1.025 | 1.066 |
| Native American | 0.994 | 0.952 | 1.038 | 0.875 | 0.822 | 0.932 | 1.124 | 1.054 | 1.199 |
| Other | 1.051 | 1.033 | 1.070 | 0.974 | 0.948 | 1.001 | 1.125 | 1.099 | 1.152 |
| Missing | 0.997 | 0.980 | 1.015 | 0.945 | 0.915 | 0.975 | 1.026 | 1.002 | 1.051 |
| Infant birth weight | |||||||||
| Reference Group Normal | |||||||||
| Very low (<1500 g) | 1.127 | 1.038 | 1.224 | 1.114 | 1.002 | 1.238 | 1.126 | 1.009 | 1.257 |
| Low (1500 < 2500 g) | 1.964 | 1.375 | 2.806 | 1.937 | 1.145 | 3.275 | 1.822 | 1.088 | 3.051 |
| High (4500 g+) | 1.074 | 0.877 | 1.314 | 1.374 | 0.956 | 1.975 | 0.899 | 0.697 | 1.160 |
| Maternal conditions | |||||||||
| Maternal distress, not specified | 1.970 | 1.610 | 2.411 | 2.018 | 1.510 | 2.697 | 1.870 | 1.396 | 2.504 |
| Placenta previa | 14.75 | 14.04 | 15.49 | 14.673 | 13.49 | 15.963 | 14.776 | 13.850 | 15.763 |
| Hypertension | 2.081 | 2.053 | 2.110 | 2.128 | 2.082 | 2.174 | 2.042 | 2.006 | 2.078 |
| Pre-eclampsia | 1.679 | 1.646 | 1.712 | 1.631 | 1.583 | 1.679 | 1.723 | 1.680 | 1.767 |
| Diabetes | 1.840 | 1.819 | 1.862 | 1.968 | 1.930 | 2.007 | 1.772 | 1.744 | 1.800 |
| Herpes | 3.062 | 2.950 | 3.178 | 3.819 | 3.608 | 4.042 | 2.552 | 2.426 | 2.686 |
| HIV | 2.986 | 2.729 | 3.268 | 3.428 | 3.078 | 3.818 | 2.201 | 1.834 | 2.641 |
| Prior myomectomy | 22.60 | 20.73 | 24.64 | 17.41 | 14.80 | 20.49 | 24.85 | 22.36 | 27.63 |
| Population characteristics | |||||||||
| Percentage of population 25 years or older with bachelor’s degree or higher | 0.993 | 0.989 | 0.997 | 0.994 | 0.990 | 0.998 | 0.994 | 0.990 | 0.998 |
| Percentage of population below poverty level | 0.998 | 0.992 | 1.004 | 0.995 | 0.987 | 1.003 | 0.998 | 0.992 | 1.004 |
| African American – Percentage in the population | 1.003 | 1.001 | 1.005 | 1.001 | 0.999 | 1.003 | 1.005 | 1.003 | 1.007 |
| Hispanic – Percentage in the population | 1.001 | 0.999 | 1.003 | 1.001 | 0.999 | 1.003 | 1.001 | 0.999 | 1.003 |
| Other – Percentage in the population | 0.998 | 0.994 | 1.002 | 0.998 | 0.994 | 1.002 | 0.998 | 0.994 | 1.002 |
| Gini Index | 1.027 | 1.015 | 1.040 | 1.023 | 1.011 | 1.035 | 1.033 | 1.020 | 1.045 |
| Market characteristics | |||||||||
| Hospital market share 1–100 (Herfindahl-Hirschman Index) | 0.999 | 0.999 | 0.999 | 0.999 | 0.997 | 1.001 | 0.998 | 0.998 | 0.998 |
| Average malpractice payment | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 |
| Number of hospital births | 1.001 | 0.999 | 1.003 | 1.001 | 0.999 | 1.003 | 1.001 | 0.999 | 1.003 |
| Percentage of acute care beds: teaching hospital | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 |
| Percentage of acute care hospitals: bed size 0–99 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 |
| Percentage of for-profit hospitals | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 | 1.000 |
| Acute care beds per 1,000 capita | 1.051 | 1.011 | 1.093 | 1.067 | 1.022 | 1.114 | 1.031 | 0.990 | 1.075 |
| OB beds per 1,000 capita | 0.936 | 0.744 | 1.177 | 0.923 | 0.710 | 1.200 | 1.028 | 0.807 | 1.311 |
| Neonatal ICU beds per 1,000 capita | 0.959 | 0.906 | 1.015 | 0.964 | 0.905 | 1.026 | 0.950 | 0.900 | 1.004 |
| Primary care medical doctors per 100,000 capita | 0.997 | 0.995 | 0.999 | 0.997 | 0.995 | 0.999 | 0.997 | 0.995 | 0.999 |
| OB/GYN physicians per 100,000 capita | 1.012 | 1.004 | 1.020 | 1.007 | 0.999 | 1.015 | 1.014 | 1.006 | 1.022 |
| Midwives per 100,000 capita | 0.991 | 0.983 | 0.999 | 0.993 | 0.983 | 1.003 | 0.991 | 0.983 | 0.999 |
SOURCE Author calculations of HCUP SID data linked with other data sources.
NOTES Model estimates are from 2 level hierarchical linear models with discharges specified as the first level and CBSAs specified as the second level. Boldface represents statistically significant results (p < .05). Abbreviations: ICU, Intensive care unit; GYN, Gynecologic; OB, Obstetric.