1971年至2003年我国剖宫产率变化趋势及社会人口学影响因素的研究

Trends of caesarean section and related social and demographic factors in China from 1971 to 2003

目的 从人群角度出发了解近32年来我国育龄妇女实际的剖宫产率变化情况及其社会人口学影响因素。 方法 采用分层、二阶段的与规模(育龄妇女人数)成正比的PPS抽样方法获得调查对象,由调查员入户对7307 名育龄妇女进行面对面的问卷调查。资料录入使用EPIDATA2.1软件,采用双录入法,数据分析使用SPSS 11.5版。 结果 随着时间推移,调查对象剖宫产率不断提高由1971至1980年的0.9%增高到2001至2002年的20.2%,发展速度越来越快,而且妇女主动要求进行的剖宫产比例不断增加,由1971至1985年的19.3% 增加到2001 至2002 年的49.7%。多因素分析显示年龄小于30岁、具有高中及以上文化程度、非农业脑力劳动及未就业、东部地区、产前检查次数9次及以上、进行了B超检查等特点的妇女剖宫产的可能性大。 结论 近几十年来我国剖宫产率不断上升,尤其是上世纪九十年代以后增加迅速。出现这种情况,一方面是因为围产科学理念的进展和科学技术发展的因素使得符合医学指征的剖宫产增加。另一方面是因为医疗机构和某些人口社会学因素使得非医学指征的剖宫产比例迅速增加,从而导致孕妇主动要求剖宫产的比例越来越高。

Objective To investigate the occurrence of cesarean section (CS) among reproductive age women in last thirty years, and explore the factors related to high CS rate. Methods Population proportional to size sampling method was employed in sampling. The sampled women were interviewed face to face. Data were double entered by EPIDATA 2.1 and analyzed by SPSS 11.5. Results The CS rate continuously increase from 0.9% in 1971-1980 to 20.2% in 2001-2002 and the speed is more and more rapid. More and more CSs were required by the women themselves and the rate increased from 19.3% in 1971-1985 to 49.7% in 2001-2002. Logistic regression analysis showed that women who were less than 30, senior high education or above and white-collar or jobless women had more than 8 times of antenatal visits, lived in eastern region and had B-ultrasound exam, were more likely to have caesarean section. Conclusions The caesarean section rate was increasing rapidly in the last thirty years especially after 1990. There are two reasons for this increase, on one hand caesa- rean sections with medical indications increase because of the progress of perinatal care and related technology; on the other hand unnecessary caesarean sections increase because of some social and demographic factors, which result in more caesarean section required by the pregnant women.