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Original Investigation
January 3, 2017

Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China, 2008-2014

Author Affiliations
  • 1Institute of Reproductive and Child Health, Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
  • 2Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
  • 3Office for National Maternal and Child Health Statistics of China, School of Public Health, Peking University Health Science Center, Beijing, China
  • 4Department of Child, Adolescent, and Women’s Health, School of Public Health, Peking University Health Science Center, Beijing, China
  • 5Department of Pediatrics, New York University School of Medicine, New York
  • 6Department of Environmental Medicine, New York University School of Medicine, New York
  • 7Department of Population Health, New York University School of Medicine, New York
  • 8Wagner School of Public Service, New York University, New York
  • 9Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
JAMA. 2017;317(1):69-76. doi:10.1001/jama.2016.18663
Key Points

Question  How has the rate of cesarean delivery in China changed between 2008 and 2014?

Findings  Cesarean rates increased from 28.8% in 2008 to 34.9% in 2014. However, there was substantial variation across China’s 31 provinces, with rates ranging from 4.0% to 62.5% in 2014.

Meaning  In 2014, the overall cesarean rate of 34.9% in China was close to the US rate of 32.4%, but there was large geographic variation in rates.

Abstract

Importance  The increasing use of cesarean delivery is an emerging global health issue. Prior estimates of China’s cesarean rate have been based on surveys with limited geographic coverage.

Objective  To provide updated information about cesarean rates and geographic variation in cesarean use in China.

Design, Setting, and Data Sources  Descriptive study, covering every county (n = 2865) in mainland China’s 31 provinces, using county-level aggregated information on the number of live births, cesarean deliveries, maternal deaths, and perinatal deaths, collected by the Office for National Maternal & Child Health Statistics of China, from 2008 through 2014.

Exposures  Live births.

Main Outcomes and Measures  Annual rate of cesarean deliveries.

Results  Over the study period, there were 100 873 051 live births, of which 32 947 229 (32.7%) were by cesarean delivery. In 2008, there were 13 160 634 live births, of which 3 788 029 (28.8%) were by cesarean delivery and in 2014 there were 15 123 276 live births, of which 5 280 124 (34.9%) were by cesarean delivery. Rates varied markedly by province, from 4.0% to 62.5% in 2014. Despite the overall increase, by 2014 rates of cesarean delieries in 14 of the nation’s 17 “super cities” had declined by 4.1 to 17.5 percentage points from their earlier peak values (median, 11.4; interquartile range, 6.3-15.4). In 4 super cities with the largest decreases, there was no increase in maternal or perinatal mortality.

Conclusions and Relevance  Between 2008 and 2014, the overall annual rate of cesarean deliveries increased in China, reaching 34.9%. There was major geographic variation in rates and trends over time, with rates declining in some of the largest urban areas.

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