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How much variation in CS rates can be explained by case mix differences?

  1. S. Paranjothy1,
  2. C. Frost2,
  3. J. Thomas1

Article first published online: 12 JAN 2005

DOI: 10.1111/j.1471-0528.2005.00501.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 112, Issue 5, pages 658–666, May 2005

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How to Cite

Paranjothy, S., Frost, C. and Thomas, J. (2005), How much variation in CS rates can be explained by case mix differences?. BJOG: An International Journal of Obstetrics & Gynaecology, 112: 658–666. doi: 10.1111/j.1471-0528.2005.00501.x

Author Information

  1. 1

    National Collaborating Centre for Women's and Children's Health, London, UK

  2. 2

    Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK

*Dr S. Paranjothy, National Collaborating Centre for Women's and Children's Health, 27 Sussex Place, London NW1 4RG, UK.

Publication History

  1. Issue published online: 12 JAN 2005
  2. Article first published online: 12 JAN 2005

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Objective  To quantify the amount of variation in caesarean section (CS) rates between maternity units explained by case mix differences.

Design  Cross-sectional study.

Setting  All 216 maternity units in England and Wales.

Population  Women giving birth at these maternity units between May and July 2000.

Methods  Logistic regression models were developed to investigate the relationship between case mix characteristics, and odds of (i) CS before labour, (ii) CS in labour. Using these results, overall CS rates standardised for case mix were calculated for each maternity unit. Random-effects meta-analysis was used to examine heterogeneity between maternity units.

Main outcome measures  CS before labour and CS during labour.

Results  Adjustment for case mix differences between maternity units explained 34% of the variance in CS rates. Odds of CS (before and in labour) increased with maternal age. Women from ethnic minority groups had lower odds of CS before labour, and increased odds of CS in labour. Women with a previous vaginal delivery had lower odds of CS, although the magnitude of this for CS before and in labour is markedly different.

Conclusions  Case mix adjustment is important to enable understanding of the factors that influence the CS rate. These include organisational and staffing levels as well as women's preferences for childbirth and clinician's attitudes. An understanding of how these factors influence the CS rate is essential for evaluation of quality and appropriateness of obstetric care provided to women.

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