Factors influencing rising caesarean section rates in China between 1988 and 2008
Xing Lin Feng, Ling Xu, Yan Guo & Carine Ronsmans
Volume 90, Number 1, January 2012, 30-39A
Table 3. Determinants of caesarean section in rural China, 1988–2008
| Determinant | No. of live births by caesarean section (%) | Relative risk of caesarean section (95% confidence interval) |
|||||
|---|---|---|---|---|---|---|---|
| Crude | Adjusted for survey year and household income | Adjusted for survey year, household income and health insurance | Adjusted for survey year, household income, health insurance and educational attainment | Adjusted for all variablesa | |||
| Year of survey | |||||||
| 1993b | 11 373 (1.5) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |
| 1998 | 3 276 (3.6) | 2.38 (1.54–3.68) | 1.82 (1.17–2.82) | 1.91 (1.28–2.86) | 1.91 (1.28–2.86) | 1.72 (1.19–2.50) | |
| 2003 | 7 174 (11.6) | 7.58 (4.86–11.82) | 5.71 (3.73–8.75) | 5.90 (3.98–8.74) | 5.78 (3.91–8.53) | 5.25 (3.77–7.30) | |
| 2008 | 6 290 (23.6) | 15.46 (10.46–22.86) | 8.49 (5.58–12.93) | 6.66 (3.98–11.15) | 6.70 (4.05–11.09) | 7.18 (4.82–10.69) | |
| Household incomec | |||||||
| Quartile 1b | 5 882 (1.7) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |
| Quartile 2 | 5 376 (3.2) | 1.65 (1.27–2.14) | 1.34 (1.04–1.74) | 1.34 (1.03–1.74) | 1.29 (0.99–1.67) | 1.11 (0.86–1.43) | |
| Quartile 3 | 5 386 (11.0) | 3.67 (2.79–4.84) | 1.85 (1.40–2.42) | 1.80 (1.38–2.36) | 1.69 (1.30–2.19) | 1.39 (1.07–1.81) | |
| Quartile 4 | 5 617 (22.9) | 9.36 (6.78–12.92) | 3.04 (2.20–4.21) | 2.91 (2.15–3.93) | 2.59 (1.94–3.46) | 1.43 (1.04–1.97) | |
| Health insurance | |||||||
| Nob | 19 860 (4.9) | 1.00 | – | 1.00 | 1.00 | 1.00 | |
| Yes | 8 253 (19.1) | 3.93 (3.15–4.90) | – | 1.45 (1.06–1.98) | 1.42 (1.04–1.92) | 1.32 (1.06–1.64) | |
| Mother’s education | |||||||
| Noneb | 4 831 (3.0) | 1.00 | – | – | 1.00 | 1.00 | |
| Primary school | 21 323 (9.4) | 3.09 (2.10–4.53) | – | – | 1.47 (1.09–1.99) | 1.07 (0.84–1.37) | |
| Secondary school | 1 677 (17.7) | 5.86 (3.78–9.07) | – | – | 2.22 (1.63–3.02) | 1.21 (0.96–1.51) | |
| College and above | 219 (29.5) | 9.75 (6.09–15.63) | – | – | 2.40 (1.68–3.43) | 1.52 (1.20–1.91) | |
| Socioeconomic regiond | |||||||
| Rural type IVb | 4 982 (1.7) | 1.00 | – | – | – | 1.00 | |
| Rural type III | 9 333 (7.2) | 4.15 (2.26–7.60) | – | – | – | 2.94 (1.80–4.80) | |
| Rural type II | 8 262 (8.7) | 5.03 (2.68–9.43) | – | – | – | 3.36 (2.01–5.63) | |
| Rural type I | 5 536 (15.5) | 8.91 (4.65–17.05) | – | – | – | 4.85 (2.88–8.19) | |
| Parity | |||||||
| 1c | 13 288 (12.2) | 1.00 | – | – | – | 1.00 | |
| 2 | 10 155 (7.5) | 0.62 (0.52–0.74) | – | – | – | 0.70 (0.62–0.79) | |
| ≥ 3 | 4 643 (2.6) | 0.22 (0.16–0.30) | – | – | – | 0.54 (0.41–0.71) | |
a Adjusted for survey year, household income, educational attainment, health insurance, maternal age, parity and number of antenatal visits.
b Reference category.
c Household income was the per capita annual income, defined as the gross household income divided by the number of individuals in the household, adjusted to 2008 values using separate annual consumer price indices for urban and rural areas. Subsequently, respondents were divided into household income quartiles in rural and urban areas separately.
d The Chinese Ministry of Health divided rural areas of the country into four socioeconomic regions according to social and economic indicators in the 1982 census: rural types I, II, III and IV, with type IV being the poorest.
The data were obtained from four cross-sectional National Health Service Surveys carried out in China in 1993, 1998, 2003 and 2008.