美国剖宫产的地域差异：趋势、相关因素及其他有趣事实

中文摘要

本文分析了涵盖近乎全部出生人口、跨越三十年的数据，研究单胎初产妇剖宫产率的县级差异。研究发现，无论在低风险组还是高风险组，剖宫产率均存在持续的地域差异。剖宫产率较高的县对手术适宜程度处于各个水平的产妇实施剖宫产的比例始终更高。在剖宫产率较高的县，较高的剖宫产率与孕产妇及婴儿发病率降低相关。我们还发现，与白人产妇相比，黑人产妇的剖宫产决策对潜在风险的响应程度较低，这表明可能存在降低福利的差异。

Abstract

Analyzing data spanning three decades covering the near universe of births, we study county-level differences in Cesarean section (C-section) rates among first-time mothers of singleton births. Our research reveals persistent geographic variation in C-section rates for both low- and high-risk groups. Counties with elevated C-section rates consistently perform more C-sections across mothers at all levels of appropriateness for the procedure. These elevated rates of C-section in high C-section counties are associated with reduced maternal and infant morbidity. We also find that C-section decisions are less responsive to underlying risks for Black mothers relative to white mothers, suggesting potential welfare-reducing disparities.