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 4. Trends in caesarean section in urban and rural China, 1988–2008, by household income, access to health insurance, women’s education and parity
| Characteristic | Reference |
Relative risk of caesarean section (95% confidence interval) |
P for interaction | |||
|---|---|---|---|---|---|---|
| 1993 | 1998 | 2003 | 2008 | |||
| Urban areas | ||||||
| Household incomea | ||||||
| Quartile 1 | 1.00 | 1.51 (1.00–2.27) | 2.58 (1.94–3.43) | 3.16 (2.17–4.61) | 0.2234 | |
| Quartile 2 | 1.00 | 1.14 (0.81–1.62) | 1.92 (1.53–2.41) | 2.29 (1.74–3.01) | ||
| Quartile 3 | 1.00 | 1.35 (0.95–1.91) | 1.99 (1.53–2.41) | 2.44 (1.87–3.20) | ||
| Quartile 4 | 1.00 | 3.85 (1.87–7.93) | 5.07 (2.61–9.84) | 6.15 (3.18–11.89) | ||
| Health insurance | ||||||
| No | 1.00 | 2.93 (2.01–4.26) | 6.17 (4.55–8.36) | 8.26 (6.04–11.28) | < 0.0001 | |
| Yes | 1.00 | 1.60 (1.27–2.01) | 2.13 (1.83–2.49) | 2.70 (2.34–3.11) | ||
| Mother’s education | ||||||
| None or primary | 1.00 | 1.59 (1.15–2.20) | 2.82 (2.26–3.52) | 3.84 (3.07–4.80) | 0.1604 | |
| Secondary | 1.00 | 1.47 (1.10–1.95) | 2.46 (2.03–2.99) | 3.02 (2.48–3.68) | ||
| College and above | 1.00 | 1.39 (0.94–2.05) | 1.84 (1.39–2.43) | 2.39 (1.82–3.13) | ||
| Parity | ||||||
| 1 | 1.00 | 1.43 (1.18–1.73) | 2.40 (2.10–2.74) | 3.19 (2.79–3.64) | 0.0818 | |
| ≥ 2 | 1.00 | 2.75 (1.37–5.52) | 4.05 (2.57–6.38) | 6.18 (4.06–9.42) | ||
| Rural areas | ||||||
| Household incomea | ||||||
| Quartile 1 | 1.00 | 1.54 (0.60–3.97) | 8.99 (5.93–13.62) | 12.13 (6.79–21.69) | 0.0026 | |
| Quartile 2 | 1.00 | 1.82 (1.08–3.08) | 6.41 (4.52–9.08) | 8.28 (5.44–12.61) | ||
| Quartile 3 | 1.00 | 1.30 (0.81–2.09) | 4.74 (3.40–6.62) | 7.54 (5.42–10.50) | ||
| Quartile 4 | 1.00 | 1.27 (0.82–1.95) | 2.89 (2.06–4.05) | 4.57 (3.30–6.31) | ||
| Health insurance | ||||||
| No | 1.00 | 3.16 (2.35–4.23) | 10.02 (8.03–12.51) | 28.71 (21.90–37.65) | < 0.0001 | |
| Yes | 1.00 | 1.24 (0.68–2.26) | 3.22 (2.38–4.34) | 4.33 (3.35–5.60) | ||
| Mother’s education | ||||||
| None | 1.00 | 1.78 (0.70–4.50) | 6.74 (3.79–12.01) | 16.56 (9.49–28.88) | 0.0034 | |
| Primary | 1.00 | 2.51 (1.88–3.35) | 7.78 (6.31–9.59) | 15.61 (12.75–19.11) | ||
| Secondary and above | 1.00 | 1.32 (0.68–2.56) | 3.14 (2.09–4.72) | 6.50 (4.48–9.42) | ||
| Parity | ||||||
| 1 | 1.00 | 1.66 (1.24–2.23) | 5.56 (4.47–6.91) | 10.71 (8.67–13.23) | < 0.0001 | |
| ≥ 2 | 1.00 | 1.95 (1.13–3.35) | 8.02 (5.95–10.81) | 21.94 (16.61–28.98) | ||
a 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.
The data were obtained from four cross-sectional National Health Service Surveys carried out in China in 1993, 1998, 2003 and 2008.