An ecological study of geographic variation and factors associated with cesarean section rates in South Korea

BMC Pregnancy and Childbirth

Agnus M. Kim¹  Yoon Kim²  Tae Ho Yoon³  Sungchan Kang⁴  Jong Heon Park⁵ 

[1] Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, South Korea;Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, South Korea;Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Republic of Korea;Department of Preventive & Occupational Medicine, School of Medicine, Pusan National University, Pusan, Republic of Korea;Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea;National Health Insurance Service, Wonju, Republic of Korea;

关键词: Korea;    Socioeconomic factors;    Geographic variation;    Cesarean section;    Obstetric delivery;    Deprivation;    Poverty;    Beds;   

DOI  :  10.1186/s12884-019-2300-0

来源: Springer

【 摘 要 】

BackgroundKorea is in a condition where the impact of patient and supplier factors on cesarean section rates can be clearly described. The cesarean section rates in Korea are among the highest in the world while the number of obstetricians is decreasing sharply. This study aimed to investigate the geographic variation in cesarean section rates in Korea and its factors.MethodsThe data were obtained from the National Health Insurance database in Korea in 2013. We calculated the age-standardized and crude cesarean section rates of 251 districts in Korea and variation statistics. A linear regression analysis was performed to determine factors for cesarean section rates.ResultsThe overall cesarean section rate in Korea was 364.6 cases per 1000 live births. The deprivation index score was strongly associated with the increase in the cesarean section rate while the density of hospital obstetricians and hospital beds showed a negative association. Average maternal age and total fertility rate showed a negative relationship with the cesarean section rate.ConclusionsKorea is suffering from a continuing decrease in obstetricians. Our study shows that this decline has more of an effect on mothers in the disadvantaged areas. Securing equal access to obstetric care among areas is necessary, and measures to encourage obstetricians and mothers not to opt for cesarean section are required.

【 授权许可】

CC BY