Effect of Health Work Force Distribution on Cesarean Rate

• Activity Number: 126
• Type: Contributed
• Date/Time: Monday, August 1, 2011 : 8:30 AM to 10:20 AM
• Sponsor: Section on Health Policy Statistics
• Author(s): Imam Xierali*+ and Catherine Livingston
• Companies: AAFP and Oregon Health & Science University
• Keywords: Cesarean rate ; Certified Nurse Midwife ; Obstetrician/Gynecologist ; health workforce ; spatial regression ; United States

Abstract

Cesarean rate has been steadily increasing in the U.S. and it varies regionally. This study examined the relationship between cesarean rate and health workforce distribution in the U.S. The 3-year (2003, 2004, and 2005) average cesarean rate by residency county of the mothers was regressed on health workforce variations and other potential county socioeconomic confounders. Cesarean rate and maternal health care workforce showed significant spatial dependence with the highest rates observed in southeast and southern U.S. Cesarean rates were significantly and negatively associated with Certified Nurse Midwife availability (p < .0001). However, Obstetrician/Gynecologist availability showed a positive association with cesarean rate (p = .0144). Moreover, the availability of Family Physicians and General Internists did not show significant association with cesarean rates. The significant spatial coefficient suggests that cesarean rate in a county was not only related to cesarean rates in nearby counties, but also related to maternal workforce availability within the county and across adjacent counties. A regional approach would be proper to address rising cesarean rate in the nation.