RACIAL ETHNIC-DIFFERENCES IN THE LIKELIHOOD OF CESAREAN DELIVERY, CALIFORNIA

Objectives. The purpose of this study was to determine whether women's sociodemographic characteristics are independently associated with ce sarean delivery.Methods. A retrospective review was conducted of hospi tal discharge data for singleton first births in California in 1991. R esults. After insurance and personal, community, medical, and hospital characteristics had been controlled, Blacks were 24% more likely to u ndergo cesarean delivery than Whites; only among low-birthweight and c ounty hospital births were Blacks not at a significantly elevated risk . Among women who resided in substantially non-English-speaking commun ities, who delivered high-birthweight babies, or who gave birth at for -profit hospitals, cesarean delivery appeared to be more likely among non-Whites and was over 40% more likely among Blacks than among Whites . Conclusions. The findings cannot establish causation, but the signif icant racial/ethnic disparities in delivery mode, despite adjustment f or social, economic, medical, and hospital factors, suggest inappropri ate influences on clinical decision making that would not be addressed by changes in reimbursement. If practice variations among providers a re involved, de facto racial differences in access to optimal care may be indicated. The role of provider and patient attitudes and expectat ions in the observed racial/ethnic differentials should also be explor ed.