Economic downturns and male cesarean deliveries: a time-series test of the economic stress hypothesis

BMC Pregnancy and Childbirth

Aaron B Caughey²  Amrita Singh¹  Yvonne W Cheng³  Tim A Bruckner¹ 

[1] Public Health & Planning, Policy and Design, University of California, Irvine, 202 Social Ecology I, Irvine, CA 92697-7075, USA;Center for Women’s Health, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd, Portland, Oregon 97239-3098, USA;Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 500 Parnassus Ave, San Francisco, California 94143, USA

关键词: Male sensitivity;    Fetal distress;    Economic stress;    Cesarean delivery;   

Others  :  1127240
DOI  :  10.1186/1471-2393-14-198

 received in 2013-03-18, accepted in 2014-05-29,  发布年份 2014

【 摘 要 】

Background

In light of the recent Great Recession, increasing attention has focused on the health consequences of economic downturns. The perinatal literature does not converge on whether ambient economic declines threaten the health of cohorts in gestation. We set out to test the economic stress hypothesis that the monthly count of cesarean deliveries (CD), which may gauge the level of fetal distress in a population, rises after the economy declines. We focus on male CD since the literature reports that male more than female fetuses appear sensitive to stressors in utero.

Methods

We tested our ecological hypothesis in California for 228 months from January 1989 to December 2007, the most recent data available to us at the time of our tests. We used as the independent variable the Bureau of Labor Statistics unadjusted total state employment series. Time-series methods controlled for patterns of male CD over time. We also adjusted for the monthly count of female CD, which controls for well-characterized factors (e.g., medical-legal environment, changing risk profile of births) that affect CD but are shared across infant sex.

Results

Findings support the economic stress hypothesis in that male CD increases above its expected value one month after employment declines (employment coefficient = -24.09, standard error = 11.88, p = .04). Additional exploratory analyses at the metropolitan level indicate that findings in Los Angeles and Orange Counties appear to drive the State-level relation.

Conclusions

Contracting economies may perturb the health of male more than female fetuses sufficiently enough to warrant more CD. Male relative to female CD may sensitively gauge the cohort health of gestations.

【 授权许可】

   
2014 Bruckner et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Elsby MW, Hobijn B, Sahin A: The labor market in the Great Recession. National Bureau of Economic Research 2010.
• [2]Marmot MG, Bell R: How will the financial crisis affect health? BMJ 2009, 338:b1314.
• [3]Catalano R: Health, medical care, and economic crisis. N Engl J Med 2009, 360(8):749-751.
• [4]Ruhm CJ: A healthy economy can break your heart. Demography 2007, 44(4):829-848.
• [5]Bruckner TA, Snowden L, Subbaraman M, Brown TT: Economic antecedents of medicaid financed mental health services among youths in California. Int J Ment Health 2010, 39(2):75-91.
• [6]Catalano R, Dooley D, Rook K: A test of reciprocal risk between undesirable economic and noneconomic life events. Am J Community Psychol 1987, 15(5):633-651.
• [7]Kasl SV, Gore S, Cobb S: The experience of losing a job: reported changes in health, symptoms and illness behavior. Psychosom Med 1975, 37(2):106-122.
• [8]Cohen F, Kemeny ME, Zegans LS, Johnson P, Kearney KA, Stites DP: Immune function declines with unemployment and recovers after stressor termination. Psychosom Med 2007, 69(3):225-234.
• [9]Dooley D, Fielding J, Levi L: Health and unemployment. Annu Rev Public Health 1996, 17:449-465.
• [10]Kessler RC, House JS, Turner JB: Unemployment and health in a community sample. J Health Soc Behav 1987, 28(1):51-59.
• [11]Dooley D, Catalano R: Economic change as a cause of behavioral disorder. Psychol Bull 1980, 87(3):450-468.
• [12]Conger RD, Conger KJ, Elder GH Jr, Lorenz FO, Simons RL, Whitbeck LB: A family process model of economic hardship and adjustment of early adolescent boys. Child Dev 1992, 63(3):526-541.
• [13]Ferrie JE, Shipley MJ, Marmot MG, Stansfeld S, Smith GD: Health effects of anticipation of job change and non-employment: longitudinal data from the Whitehall II study. BMJ 1995, 311(7015):1264-1269.
• [14]Vahtera J, Kivimaki M, Pentti J: Effect of organisational downsizing on health of employees. Lancet 1997, 350(9085):1124-1128.
• [15]Catalano RA, Bruckner T: Economic antecedents of the Swedish sex ratio. Soc Sci Med 2005, 60(3):537-543.
• [16]Catalano RA: Sex ratios in the two Germanies: a test of the economic stress hypothesis. Hum Reprod 2003, 18(9):1972-1975.
• [17]Catalano R, Bruckner T, Gould J, Eskenazi B, Anderson E: Sex ratios in California following the terrorist attacks of September 11, 2001. Hum Reprod 2005, 20(5):1221-1227. Epub 2005 Feb 1225
• [18]Owen D, Matthews SG: Glucocorticoids and sex-dependent development of brain glucocorticoid and mineralocorticoid receptors. Endocrinology 2003, 144(7):2775-2784.
• [19]Matthews SG, Owen D, Banjanin S, Andrews MH: Glucocorticoids, hypothalamo-pituitary-adrenal (HPA) development, and life after birth. Endocr Res 2002, 28(4):709-718.
• [20]Catalano R, Bruckner T, Anderson E, Gould JB: Fetal death sex ratios: a test of the economic stress hypothesis. Int J Epidemiol 2005, 15:15.
• [21]Bruckner TA, Catalano R, Ahern J: Male fetal loss in the U.S. following the terrorist attacks of September 11, 2001. BMC Public Health 2010, 10:273. BioMed Central Full Text
• [22]Catalano R, Hansen HT, Hartig T: The ecological effect of unemployment on the incidence of very low birthweight in Norway and Sweden. J Health Soc Behav 1999, 40:422-428.
• [23]Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Kirmeyer S, Munson ML: Births: final data for 2005. Natl Vital Stat Rep 2007, 56(6):1-103.
• [24]Smith GCS, Pell JP, Cameron AD, Dobbie R: Risk of perinatal death associated with labor after previous cesarean delivery in uncomplicated term pregnancies. JAMA 2002, 287(20):2684-2690.
• [25]Clark SL, Belfort MA, Dildy GA, Herbst MA, Meyers JA, Hankins GD: Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol 2008, 199(1):36.e31-36.e35.
• [26]Zlatnik MG, Cheng YW, Norton ME, Thiet M-P, Caughey AB: Placenta previa and the risk of preterm delivery. J Matern Fetal Neonatal Med 2007, 20(10):719-723.
• [27]Hendrix NW, Chauhan SP: Cesarean delivery for nonreassuring fetal heart rate tracing. Obstet Gynecol Clin North Am 2005, 32(2):273-286. ix
• [28]Catalano R, Zilko CE, Saxton KB, Bruckner T: Selection in utero: a biological response to mass layoffs. Am J Hum Biol 2010, 22(3):396-400.
• [29]California Department of Health Services CfHS: Birth cohort public use file, 1993–2003. Sacramento; 2006.
• [30]Local Area Unemployment Statistics. United States Bureau of Labor Statistics Web site; http://www.bls.gov/lau/ webcite
• [31]Thirlwall AP: Types of unemployment: with special reference to ‘Non-Demand Efficient’ unemployment in Great Britain. Scottish J Pol Econ 1969, 16(3):20-49.
• [32]Box G JG, Reinsel G: Time Series Analysis: Forecasting and Control. 3rd edition. London: Prentice Hall; 1994.
• [33]Dickey D, Fuller W: Distribution of the estimators for autoregressive time series with a unit root. J Am Stat Assoc 1979, 74:427-431.
• [34]Catalano R, Serxner S: Time series designs of potential interest to epidemiologists. Am J Epidemiol 1987, 126(4):724-731.
• [35]Chang I, Tiao G, Chen C: Estimation of time series parameters in the presence of outliers. Technometrics 1988, 30:193-204.
• [36]Ford DE, Kamerow DB: Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA 1989, 262(11):1479-1484.
• [37]Hyyppa MT, Kronholm E, Alanen E: Quality of sleep during economic recession in Finland: a longitudinal cohort study. Soc Sci Med 1997, 45(5):731-738.
• [38]Lee KA, Gay CL: Sleep in late pregnancy predicts length of labor and type of delivery. Am J Obstet Gynecol 2004, 191(6):2041-2046.
• [39]Catalano R, Serxner S: The effect of ambient threats to employment on low birthweight. J Health Soc Behav 1992, 33(4):363-377.
• [40]Dehejia R, Lleras-Muney A: Booms, busts, and babies’ health. Q J Econ 2004, 119(3):1091-1130.
• [41]Dooley D, Prause J: Birth weight and mothers’ adverse employment change. J Health Soc Behav 2005, 46(2):141-155.
• [42]Zilko CE: Economic contraction and birth outcomes: an integrative review. Hum Reprod Update 2010, 16(4):445-458.
• [43]Catalano RA, Saxton KB, Bruckner TA, Pearl M, Anderson E, Goldman-Mellor S, Margerison-Zilko C, Subbaraman M, Currier RJ, Kharrazi M: Hormonal evidence supports the theory of selection in utero. Am J Hum Biol 2012, 24(4):526-532.
• [44]Angeja AC, Washington AE, Vargas JE, Gomez R, Rojas I, Caughey AB: Chilean women's preferences regarding mode of delivery: which do they prefer and why? BJOG 2006, 113(11):1253-1258.
• [45]Anderson GM: Making sense of rising caesarean section rates. BMJ 2004, 329(7468):696-697.
• [46]Gruber J, Kim J, Mayzlin D: Physician fees and procedure intensity: the case of cesarean delivery. J Health Econ 1999, 18(4):473-490.
• [47]Yang YT, Mello MM, Subramanian SV, Studdert DM: Relationship between malpractice litigation pressure and rates of cesarean section and vaginal birth after cesarean section. Med Care 2009, 47(2):234-242.
• [48]Wiegand S: California Budget Q&A: How Did We Get Here? Where Are We Going?. Sacramento: The Samcamento Bee; 2009.