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Rev Esp Salud Publica. 2011 Mar-Apr;85(2):205-15. doi: 10.1590/S1135-57272011000200008.

[Caesarean delivery in Andalusia, Spain: relationship with social, clinical and health services factors (2007-2009)].

[Article in Spanish]

Author information

1
Secretaría General de Salud Pública y Participación, Consejería de Salud de Junta de Andalucía, Sevilla. soledadm.marquez@juntadeandalucia.es

Abstract

BACKGROUND:

Increasing trend and geographical variations in the use of caesarean section suggest the influence of non-clinical factors. The objective was to describe the use of caesarean section in the Andalusian region in Spain by exploring the role of social, clinical, and health services variables.

METHODS:

A cross-sectional study was carried out using vital statistics. It involves all births occurred in Andalusia during the period of 2007-2009. The dependent variable was the use of caesarean section and the set of covariates were classified into three groups: those with a clinical meaning, those related to the health services organization, and those with a social significance. Multivariate logistic regressions were used.

RESULTS:

In the data set of 293,558 births, the prevalence of caesarean delivery was 24.8%. The multivariate analysis highlights the labour complications as the clinical variable with the highest odds ratio (OR=19.36). Regarding the health services variables, the odds of experiencing a caesarean delivery were 55% higher on weekdays than on weekends. Cádiz was the province with the highest OR for caesarean section (comparison between Cádiz and Almería: OR=1,21) where the ratio between births in public and private hospitals was 3.7. The frequency of caesarean section was 34% higher in women with third level education than those with no education.

CONCLUSIONS:

Labour complication is the most influential variable for caesarean section. Caesarean birth rate is above the accepted standards for all social classes and increases with educational level. Inter-provincial differences reflect different patterns with regard to the use of private medicine.

PMID:
21826382
DOI:
10.1590/S1135-57272011000200008
[Indexed for MEDLINE]
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