Perinatal & Pediatric
Low-Risk Cesarean Delivery Rates at the County Level: Progress toward Healthy People 2030 Objectives Lauren Rossen* Rachael Beer Michelle Osterman Lauren Rossen
Background: A Healthy People (HP) 2030 objective is to decrease cesarean deliveries among low-risk women with no prior births. Previous analyses have shown substantial geographic variability in low-risk cesarean delivery rates but have been limited to the state level. We estimate county-level rates to measure progress toward the HP2030 objective, assess geographic patterns in rates, and evaluate potential disparities by race/ethnicity.
Methods: Using 2023 US National Vital Statistics Natality data, we modeled county-level low-risk cesarean delivery rates with Bayesian hierarchical models that spatially smooth unstable estimates. We then determined the number of counties that met the HP2030 target rate of 23.6%, mapped county-level rates to assess geographic patterns, and generated county-level estimates by race/ethnicity to assess disparities.
Results: Of 3129 counties with at least one low-risk birth, 1016 (32.5%) achieved the HP2030 target low-risk cesarean delivery rate in 2023, and 471 (15.1%) had reduced rates since 2018. These results differed by race/ethnicity; among Non-Hispanic (NH) Black, NH Asian, NH Native Hawaiian/Other Pacific Islander (NHOPI), NH Multiracial/Unknown, NH White, Hispanic, and NH American Indian/Alaska Native (AIAN) groups, 1.9%, 2.5%, 25.5%, 37.1%, 37.3%, 40.4%, and 68.4% of counties with low-risk births met the HP2030 target, respectively. Geographically, counties in the West and Midwest tended to have lower rates that met the HP2030 goal, while counties in the South and Northeast tended to have higher rates. This pattern was also present among NH White, NH AIAN, NH NHOPI, NH Multiracial/Unknown, and Hispanic populations. Among NH Black and NH Asian populations, rates tended to be high across the US.
Conclusions: Overall, nearly one-third of counties achieved the HP2030 target in 2023. However, there were substantial disparities by race/ethnicity, with few counties meeting the HP2030 target for NH Black and NH Asian populations.
