Background: Racial disparities in maternal morbidity and mortality remain a pressing public health problem. Variations in cesarean section (C-section) rates among racial and ethnic groups have been well documented, though reasons for these variations remain unknown. In the Department of Veterans Affairs (VA), nearly half of all women Veterans are of reproductive age and >40% of these women are racial and ethnic minorities. Because the VA does not provide obstetrical services, all obstetrical care is provided by community obstetrical providers under the auspices of the VA Community Care Network. However, little is known regarding the rates and correlates of C-sections among women Veterans receiving community obstetrical care.
Objective: To examine predictors of C-section deliveries among a cohort of racially diverse pregnant Veterans enrolled in VA care at 15 VA medical facilities nationwide.
Research Design: Cross-sectional analysis of a longitudinal, prospective, multisite, observational cohort study of pregnant, and postpartum Veterans receiving community-based obstetrical care.
Results: Overall, 659 Veterans delivered babies during the study period, and 35% of the deliveries were C-sections. Predictors of C-section receipt included being a woman of color [adjusted odds ratio (AOR), 1.76; 95% confidence interval (CI), 1.19-2.60], having an Edinburgh Postnatal Depression Scale score ≥10 (AOR, 1.71; 95% CI, 1.11-2.65), having a higher body mass indexes (AOR, 1.07; 95% CI, 1.04-1.11), and women who were older (AOR, 1.08; 95% CI, 1.03-1.13). There was a substantial racial variation in C-section rates across our 15 study sites, with C-section rates meeting or exceeding 50% for WOC in 8 study sites.
Conclusions: There is substantial racial and geographic variation in C-section rates among pregnant Veterans receiving obstetrical care through VA community care providers. Future research should carefully examine variations in C-sections by the hospital, and which providers and hospitals are included in VA contracts. There should also be an increased focus on the types of providers women Veterans have access to for obstetrical care paid for by the VA and the quality of care delivered by those providers.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/MLR.0000000000001461 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Revisiting Injectable Estrogen Dosing Recommendations for Gender-Affirming Hormone Therapy.
Transgend Health
December 2024
Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA.
Injectable estrogens are options for gender-affirming hormone therapy per guidelines, which suggest intramuscular dosages of 5-30 mg every 2 weeks or 2-10 mg weekly with estradiol cypionate or valerate interchangeably. Data among transgender and gender-diverse patients are limited due to local unavailability and concerns around laboratory assay variability and estradiol (E2) level fluctuation. We note a concerning trend where patients are prescribed high-dose injections based on the guidelines leading to serum E2 levels well above the range recommended in the same guidelines.
View Article and Find Full Text PDFPreadmission VACS Index as a Predictor of Hospital Acute Kidney Injury in People with HIV.
J Acquir Immune Defic Syndr
December 2024
Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY.
Background: The Veterans Aging Cohort Study (VACS) Index is a summary measure of routinely obtained clinical variables that predicts numerous health outcomes. Since there are currently no tools to predict acute kidney injury (AKI) in persons with HIV (PWH), we investigated the association of preadmission VACS Index with hospital AKI in PWH.
Methods: We conducted an observational study of PWH hospitalized in a New York City health system between 2010-2019.
Metabolic Aging as an Increased Risk for Chronic Obstructive Pulmonary Disease.
Metabolites
November 2024
Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH 44106, USA.
Background/objectives: Both aging and chronic obstructive pulmonary disease (COPD) are strongly associated with changes in the metabolome; however, it is unknown whether there are common aging/COPD metabolomic signatures and if accelerated aging is associated with COPD.
Methods: Plasma from 5704 subjects from the Genetic Epidemiology of COPD study (COPDGene) and 2449 subjects from Subpopulations and intermediate outcome measures in COPD study (SPIROMICS) were profiled using the Metabolon global metabolomics platform (1013 annotated metabolites). Post-bronchodilator spirometry measures of airflow obstruction (forced expiratory volume at one second (FEV)/forced vital capacity (FVC) < 0.
Impacts of osteosarcopenia on musculoskeletal health, risks of falls and fractures, and activities of daily living among population aged 50 and above: an age- and sex-matched cross-sectional analysis.
Aging Clin Exp Res
December 2024
Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Aims: We conducted this study to investigate the impact of muscle loss on musculoskeletal health, fall and fracture risks, and activities of daily living (ADL) in elderly patients with osteoporosis.
Materials And Methods: This age- and sex-matched cross-sectional study analyzed data from a medical center involving patients aged ≥ 50 from 2020 to 2022. The included participants were formed into three groups: 100 with osteoporosis only, 100 with osteosarcopenia, and 50 control individuals without osteoporosis and sarcopenia.
Urothelial carcinoma in situ with "early papillary formation" vs "lateral spread/shoulder lesion" of prior high-grade noninvasive papillary urothelial carcinoma: A survey of pathologist and urologist interpretations.
Am J Clin Pathol
December 2024
Department of Pathology and Laboratory Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States.
Objectives: Urothelial carcinoma in situ (CIS) with early papillary formation is terminology sometimes used to suggest incipient high-grade papillary urothelial carcinoma (PUC) but may lead to confusion between true CIS and lateral flat spread of PUC.
Methods: It remains unclear how pathologists and urologists interpret this scenario, so a survey was circulated to 68 pathologists (group 1 = 28 academic genitourinary pathologists; group 2 = 17 pathologists with a self-reported genitourinary focus; group 3 = 23 pathologists self-reported as not genitourinary specialists) and 32 urologists.
Results: Regarding atypical urothelial lesions that appear mainly flat but contain possible papillae, group 3 was more likely to label this as CIS compared with groups 1 and 2 (35% for group 3 vs 13% for groups 1 and 2), while groups 1 and 2 more often adopted another descriptive diagnosis, such as "CIS with early papillary features" (38% for groups 1 and 2 vs 13% for group 3).
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!