Figure 2. Trends in Cesarean Delivery Rates in China by Type of Geographical Area, 2008-2018.

Supercities were defined as urban areas with a population of 5 million or greater, general cities as urban areas with a population of less than 5 million, and rural areas as nonurban counties. Solid data markers indicate annual cesarean delivery rates for each type of geographical area from China’s National Maternal and Child Health Statistics data set. The open data markers indicate estimates for 2007 based on linear extrapolation. Joinpoint regression was used to estimate the overall annual percentage change (APC) for 2008 to 2018 for each type of geographic area: supercity, −2.1 (95% CI, −2.9 to −1.3; P < .001); general city, 0 (95% CI, −0.7 to 0.8; P = .95); and rural area, 2.9 (95% CI, 2.1-3.6; P < .001). Pairwise comparisons of these changes for each of the 3 types of geographical areas rejected the null hypothesis of parallelism in each case at P < .001. Joinpoint regression also was used to identify up to 3 segments and relied on the additional extrapolated point for 2007. Three segments were identified for supercities and general cities and 2 for rural areas. The superimposed trend lines show the segments.

^aP < .05.