Urbanization and the likelihood of a cesarean section

Objective: This study examines the association between the likelihood of cesarean section (CS) and the degree of urbanization in Taiwan, exploring possible explanations for the difference. Study design: The database used in this study was the Taiwan 2004 National Health Insurance Research Database. A total of 200,207 singleton deliveries fulfilled our criteria and were included in our study. The urbanization level of cities/towns where parturients resided at the time of delivery was stratified into seven categories. A multilevel logistic regression model was applied to examine the relative likelihood of CS by urbanization level after adjusting for parturient, physician and hospital characteristics. Results: There was an upward trend in the CS rate with advancing urbanization level; the CS rates for urbanization level 1 (most urbanized) through 7 (least urbanized) were 33.7, 32.3, 30.4, 30.2 29.7, 29.5, and 28.6%, respectively. Compared with participants living at the highest urbanization level, the adjusted odds of a CS were 0.91 (95% CI = 0.85-0.98, p = 0.014), 0.84 (95% CI = 0.78-0.91, p <0.001), 0.83 (95% CI = 0.68-0.88, p <0.001), 0.79 (95% CI = 0.72-0.86, p <0.001), and 0.70 (95% CI = 0.62-0.80, p <0.001) times, respectively, for those living in cities/towns ranked from the third highest to the lowest levels of urbanization. Conclusions: We conclude that higher urbanization levels were associated with higher odds of CS. Highly urbanized communities could therefore be targeted for policy intervention aimed at reducing the unnecessary CS rate.