40089 - CESAREAN SECTIONS AND SOCIAL INEQUALITIES IN 305 CITIES OF LATIN AMERICA
MÓNICA SERENA PERNER - INSTITUTE OF COLLECTIVE HEALTH, NATIONAL UNIVERSITY OF LANUS, ARGENTINA., ANA F ORTIGOZA - DORNSIFE SCHOOL OF PUBLIC HEALTH, DREXEL UNIVERSITY, USA., ANDRÉS TROTTA - INSTITUTE OF COLLECTIVE HEALTH, NATIONAL UNIVERSITY OF LANUS, ARGENTINA., GORO YAMADA - DORNSIFE SCHOOL OF PUBLIC HEALTH, DREXEL UNIVERSITY, USA., ARIELA BRAVERMAN - DORNSIFE SCHOOL OF PUBLIC HEALTH, DREXEL UNIVERSITY, USA., AMÉLIA AUGUSTA FRICHE - FEDERAL UNIVERSITY OF MINAS GERAIS, BRAZIL., MARCIO ALAZRAQUI - INSTITUTE OF COLLECTIVE HEALTH, NATIONAL UNIVERSITY OF LANUS, ARGENTINA., ANA V DIEZ ROUX - DORNSIFE SCHOOL OF PUBLIC HEALTH, DREXEL UNIVERSITY, USA.
Apresentação/Introdução
Cesarean section (CS) is a surgical procedure that, when medically justified, can help reduce maternal and infant morbi-mortality. Worldwide CS rates have been increasing; Latin America has rates that are among the highest in the world. Important inequalities in the use of this procedure between and within countries. Unnecessary CS impose important costs on financially stretched health systems.
Objetivos
Aim. Describe the variability of CSR across 305 cities in Brazil, Colombia, Guatemala, Mexico, and Peru and examine the relationship of individual-level, sub-city, and city-level socioeconomic status (SES) with CSR.
Metodologia
We used individual level data from vital statistics from 2014-2016 (delivery method, mother´s age and education), census data for sub-city SES and city GDP from other sources compiled by the SALURBAL project. To estimate the proportion of variability in sub-city CSR between cities and countries we fit a linear multilevel model, to assess the association of maternal, sub-city and city SES with CSR, multilevel negative binomial models. For the latter, counts of cesarean deliveries and of live births were calculated for cross-classified cells of maternal age and education, these were nested within sub-cities and cities. The SALURBAL study protocol was approved by the Drexel University IRB.
Resultados
11,549,028 live births from 1,101 sub-city units in 305 cities of five countries were included. Overall, the CSR was 52%, with a wide range across sub-cities (13-91%). Of the total variability in sub-city CSRs, 67% was within countries. In fully adjusted model higher CSR was associated with higher maternal education [(PRR (CI95%) 0.81 (0.80-0.82) for lower educational level, 1.32 (1.31-1.33) for higher level (ref. medium category)], higher sub-city SES [(PRR (CI95%) 1.02 (1.01-1.03) per 1SD)], and higher city GDP per capita [(PRR (CI95%): 1.03 (1.00-1.07) for GDP between 10,500-18,000, and 1.09 (1.06-1.13) for GDP 18,000 or more (ref. <10,500)].
Conclusões/Considerações
We found wide variability in CSR across cities highlighting the potential role of local policies in CSR levels. Possible drivers of these associations may include the medicalization of births and features of health-care system and process. Further research is needed to understand the reasons for this pattern and any policy implications it may have.
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