RACE, AGE, AND CESAREAN DELIVERY IN A MILITARY POPULATION

Objective: To evaluate the relationship between race, age, and the ris k of cesarean delivery. Methods: This was a cohort study of 3603 nulli parous enlisted United States Navy women who were on active duty and h ad a singleton delivery between October 1987 and September 1989. Type of delivery and complications of pregnancy, labor, or delivery were id entified through hospital discharge diagnoses codes. Demographic risk factors were obtained from military personnel files. Results: Women ov er age 30 had a significantly increased risk of cesarean delivery (odd s ratio [OR] 1.4, 95% confidence interval [CI] 1.1-1.9) compared with women under age 30. Multiple logistic regression modeling adjusted for education, marital status, military rank, type of hospital, and compl ications of pregnancy, labor and delivery showed African-American wome n over age 30 to have a significantly increased risk for cesarean deli very (OR 2.2, 95% CI 1.1-4.2) compared with white women over age 30. A mong women under 30, African-Americans were not at a greater risk of c esarean delivery (OR 1.1; 95% CI 0.89-1.3). Other demographic factors were not related to the risk of cesarean delivery, but complications o f pregnancy, labor, and delivery were strong predictors. Conclusion: W e observed an increased risk in this unique population over age 30. Ac tive duty military women serve as a useful population to examine demog raphic differences because of equitable access to medical care.