Rural-urban and racial differences in cesarean deliveries before and during the COVID-19 pandemic in South Carolina.
Cassie L Odahowski, Peiyin Hung, Berry A Campbell and 7 others
PMID 38941782WHAT IT FOUND
Black birthing people in urban hospitals were more likely to have a low-risk cesarean than White birthing people before and during the pandemic.
The study did not show that the pandemic consistently widened these gaps.
Key findings
01After adjustment, Black birthing people in urban hospitals had higher odds of low-risk cesarean than White birthing people before the pandemic (aOR=1.34) and during the pandemic (aOR=1.19).
02Rural Black versus White low-risk cesarean odds were higher before the pandemic (aOR=1.28) but not significant during the pandemic (aOR=1.13, 95%CI 0.99 to 1.29).
03For primary cesarean, adjusted Black versus White differences were not significant in urban hospitals, and Black rural birthing people had lower odds during the pandemic (aOR=0.87).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used administrative birth certificate and claims data, so it could not see the clinical reasons for each cesarean or whether the patient or provider chose it. It did not record whether birthing patients were positive for COVID-19 at delivery, which could have affected cesarean decisions. It compared pre-pandemic and peri-pandemic groups but did not use a difference-in-difference design to test changes over time. The South Carolina Hispanic population was small, so Hispanic findings may not represent Hispanic birthing people in other states. Medical coding can misclassify outcomes, although the team validated cesarean deliveries against birth certificate records. The study did not measure nursing or obstetric care processes, so it cannot identify which clinical actions produced the differences.
Declared interests
The authors declared no competing interests. The article metadata lists NIH extramural research support, but the text does not state a funder role.
The easy way to misread this
Do not conclude that the pandemic made cesarean disparities worse. The study did not test before-and-after changes, and several adjusted differences were not significant during the pandemic.