Time trends in births and cesarean deliveries among women with disabilities.
Willi Horner-Johnson, Frances M Biel, Blair G Darney and 1 others
PMID 28431988WHAT IT FOUND
The share of California births to women with disability-related diagnosis codes rose from 0.27% in 2000 to 0.80% in 2010.
First cesarean rates were 30.2% for women with disabilities in 2010, compared with 17.9% for women without disabilities.
Key findings
01The share of births to women with a disability-related diagnosis code in California rose from 0.27% in 2000 to 0.80% in 2010.
02In 2010, 30.2% of deliveries to the overall disability group were primary cesarean deliveries, compared with 17.9% of deliveries to women without disabilities. Adjusted odds ratios for primary cesarean delivery among women with any disability decreased from 2.60 in 2000 to 1.66 in 2010.
03Time trends varied by disability type. Women with vision limitations had the highest primary cesarean proportions, including 54.0% in 2003, 49.6% in 2009, and 47.7% in 2010, while women with intellectual/developmental disabilities ended at 42.3% in 2010.
STILL TO COME
How it was doneWhat they found
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Disability was identified only from diagnosis codes in the delivery record, not from full medical records, so some women with disabilities may have been missed. Because the codes came from the delivery record, they may have overrepresented disabilities that were obvious or relevant to birth. This may inflate the link with cesarean delivery. The study could not tell whether a cesarean delivery was medically necessary, based on clinician judgment, or related to other factors. Coding accuracy may have changed over time. Year-to-year changes in the proportion of births with disability codes may not be precise. The estimates for hearing, vision, and intellectual/developmental disability groups were based on smaller yearly samples and were not adjusted for covariates. The analysis excluded multiple gestations, breech presentations, very early births, and women with previous cesareans for the primary cesarean outcome. It does not describe all pregnancies. The data were from California births from 2000 to 2010, so they may not apply to other places or later years. The study is observational. It shows patterns over time but does not show that disability caused cesarean delivery.
Declared interests
The authors report no conflicts of interest. The article is listed as supported by NIH, U.S. government, and non-U.S. government sources.
The easy way to misread this
Do not conclude that disability itself requires cesarean delivery. The study found higher primary cesarean proportions among women with disability codes, but it did not record the reasons for cesarean delivery or whether each cesarean was medically necessary. The adjusted odds ratio, which compares the odds of a primary cesarean in women with disabilities with those in women without disabilities, decreased from 2.60 in 2000 to 1.66 in 2010.