2003-2013年吉林省剖宫产率变化趋势及影响因素分析

Analysis on the change trend and influencing factors of cesarean section rates in Jilin province from 2003 to 2013

目的描述吉林省2003年至2013年剖宫产率变化趋势,分析该地区剖宫产率的影响因素。方法利用2008年和2013年国家卫生服务调查家庭健康询问调查数据描述吉林省剖宫产率的变化趋势,应用Logistic回归分析剖宫产率的影响因素。结果共纳入1 069名近5年内有分娩的妇女进行分析。将2008年和2013年两次调查数据进行对比(67.1%~66.8%),发现城市地区的剖宫产率一直处于高位(OR=1.00,95%CI=0.56~1.80),农村地区剖宫产率(41.3%~63.4%)则大幅升高(OR=2.45,95%CI=1.39~4.33),农村地区剖宫产率的增加趋势不能被分娩机构、医疗保险覆盖、产次、教育水平、收入等因素解释(a OR=2.13,95%CI=1.52~3.30)。与农村县级以下医疗机构相比,县级以上分娩机构剖宫产率较高(aOR=0.37,95%CI=0.23~0.59)。无论城乡,经产妇剖宫产率与初产妇相比无统计学差异(a OR=1.52、1.09)。结论吉林省的剖宫产率处于较高的水平,农村地区剖宫产率增长速度较快,卫生服务体系因素可能是剖宫产率的主要影响因素。

Objective To describe the change trend of cesarean section rates in Jilin province from 2003 to 2013, analyze the influen- cing factors. Methods The change trend of cesarean section rates in Jilin province was described based on national health service survey data and household inquiring survey data in 2008 and 2013. Logistic regression analysis was used to analyze the infll^encing factors of cesarean section rate. Results A total of 1 069 women having birth history, in recent 5 years were included in the study. The survey data in 2008 and 2013 were compared （67. 1% -66. 8% ）, cesarean section rate in urban areas kept at a high level （ OR= 1.00, 95% CI=0. 56-1.80） , while cesarean section rate in rural areas （41.3% -63.4% ） increased significantly （ OR=2. 45, 95% CI= 1.39-4. 33）, which couldn＇t be explained by delivery organization, coverage of medical insurance, parity, educational level, and income （ aOR = 2. 13, 95% CI= 1.52- 3.30） . Compared with the delivery organizations below county level, cesarean section rate in delivery orgauizations above county level was high （ aOR = 0. 37, 95 % CI= 0. 23-0. 59 ） . Wherever in urban and rural areas, there was no statistically significant difference in cesarean section rate between primiparous women and muhiparous women （ aOR = 1.52, 1.09） . Conclusion Cesarean section rate in Jilin province is high, which increases rapidly in rural areas, health service system may be the main influencing factor of cesarean section rate.