Differences in Cesarean Rates for Nulliparous, Term, Singleton, Vertex Births Among Racial and Ethnic Groups and States Before and After Stay-at-Home Orders During the COVID-19 Pandemic, United States, 2017-2021.

Publisher: SAGE Publications Country of Publication: United States NLM ID: 9716844 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-2877 (Electronic) Linking ISSN: 00333549 NLM ISO Abbreviation: Public Health Rep Subsets: MEDLINE

Publication: Thousand Oaks, CA : SAGE Publications
Original Publication: Hyattsville, Md. : Washington, D.C. : U.S. Dept. of Health, Education, and Welfare, Public Health Service, Health Resources Administration ; Supt. of Docs., U.S. G.P.O., distributor,

Cesarean Section*/statistics & numerical data ; Ethnicity*/statistics & numerical data ; Racial Groups*/statistics & numerical data; Female ; Humans ; Pregnancy ; COVID-19/epidemiology ; COVID-19/ethnology ; Pandemics ; Parity ; United States/epidemiology

Objectives: Evidence is limited on differences in cesarean rates for nulliparous, term, singleton, vertex (NTSV) births across racial and ethnic groups at the national and state level during the COVID-19 pandemic. We assessed changes in levels and trends of NTSV cesarean rates before and after stay-at-home orders (SAHOs) were implemented in the United States (1) overall, (2) by racial and ethnic groups, and (3) by 50 US states from January 2017 through December 2021.
Methods: We used birth certificate data from 2017 through 2021, restricted to hospital births, to calculate monthly NTSV cesarean rates for the United States and for racial and ethnic groups and to calculate quarterly NTSV cesarean rates for the 50 states. We used interrupted time-series analysis to measure changes in NTSV cesarean rates before and after implementation of SAHOs (March 1 through May 31, 2020).
Results: Of 6 022 552 NTSV hospital births, 1 579 645 (26.2%) were cesarean births. Before implementation of SAHOs, NTSV cesarean rates were declining in the United States overall; were declining among births to non-Hispanic Asian, non-Hispanic Black, Hispanic, and non-Hispanic White women; and were declining in 6 states. During the first month of implementation of SAHOs in May 2020, monthly NTSV rates increased in the United States by 0.55%. Monthly NTSV rates increased by 1.20% among non-Hispanic Black women, 0.90% among Hispanic women, and 0.28% among non-Hispanic White women; quarterly NTSV rates increased in 6 states.
Conclusion: In addition to emergency preparedness planning, hospital monitoring, and reporting of NTSV cesarean rates to increase provider awareness, reallocation and prioritization of resources may help to identify potential strains on health care systems during public health emergencies such as the COVID-19 pandemic.
Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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CC999999 United States ImCDC Intramural CDC HHS

Keywords: COVID-19; cesarean births; interrupted time series; racial and ethnic differences; stay-at-home orders

Date Created: 20240320 Date Completed: 20240824 Latest Revision: 20240902

20240902

PMC11344689

10.1177/00333549241236629

38504483