Trends in the Beijing cesarean section rate and reasons for the fluctuations

[...]a delivery with diagnoses of both fetal distress and dystocia-related factors would be assigned to the category “dystocia-related factors,” while a scarred uterus superseded all other diagnoses. The study protocol was approved by the Medical Ethics Committee of Beijing Obstetrics and Gynecology Hospital, Capital Medical University (No. 2018-KY-070-01). Characteristics 2012n = 108,940 2013n = 105,750 2014n = 144,444 2015n = 96,839 2016n = 147,012 2017n = 130,935 AAPC% (95% CI) F or χ2 P Age (mean ± SD) 29.2 ± 4.09 29.4 ± 4.16 29.5 ± 3.93 30.4 ± 4.33 30.4 ± 4.05 31.3 ± 4.27 1.4 (0.8–2.0) 4,805.208 < 0.001 Age, n (%) 23,921.110 < 0.001 Under 20 years 684 (0.6) 621 (0.6) 539 (0.4) 428 (0.4) 276 (0.2) 217 (0.2) −22.2 (−31.0–−12.3) 20–24 years 12,433 (11.4) 11,599 (11.0) 11,955 (8.3) 7,036 (7.3) 7,739 (5.3) 5,609 (4.3) −18.6 (−22.6–−14.3) 25–29 years 45,828 (42.1) 43,545 (41.2) 63,778 (44.2) 35,355 (36.5) 60,526 (41.2) 42,450 (32.4) −4.2 (−9.9–1.8) 30–34 years 39,963 (36.7) 38,854 (36.7) 53,511 (37.0) 37,547 (38.8) 55,100 (37.5) 51,636 (39.4) 1.3 (0.1–2.6) 35–39 years 8488 (7.8) 9411 (8.9) 12,706 (8.8) 14,287 (14.8) 20,544 (14.0) 26,683 (20.4) 21.0 (10.3–32.8) ≥40 years 1544 (1.4) 1720 (1.6) 1955 (1.4) 2186 (2.3) 2827 (1.9) 4340 (3.3) 16.3 (2.1–32.6) Marital status, n (%) 1,513.325 < 0.001 Married 107,193 (98.4) 104,422 (98.7) 142,442 (98.6) 94,269 (97.3) 14,4549 (98.3) 129,833 (99.2) 0 (−0.4–0.5) Unmarried and others 1709 (1.6) 1292 (1.2) 1900 (1.3) 2500 (2.6) 2342 (1.6) 879 (0.7) −7.1 (−31.4–25.8) Data missing 38 (0.0) 36 (0.0) 102 (0.1) 70 (0.1) 121 (0.1) 233 (0.2) Employment, n (%) 10,546.656 < 0.001 Employed 56,016 (51.4) 55,099 (52.1) 79,118 (54.8) 48,016 (49.6) 88,446 (60.2) 77,760 (59.4) 3.1 (−1.1–7.4) Unemployed 32,073 (29.4) 29,386 (26.8) 26,410 (18.3) 18,161 (18.8) 23,695 (16.1) 19,648 (15.0) −13.0 (−18.4–−7.2) Data missing∗ 20,851 (19.1) 22,265 (21.1) 38,916 (26.9) 30,662 (31.7) 34,871 (23.7) 33,527 (25.6) Resident place, n (%) 3707.568 < 0.001 Urban area 50,683 (46.5) 49,858 (47.1) 64,815 (44.9) 46,111 (47.6) 63,235 (43.0) 54,245 (41.4) −2.2 (−4.8–0.4) Suburbs 31,803 (29.2) 35,144 (33.2) 52,014 (36.0) 33,904 (35.0) 58,435 (39.7) 52,420 (40.0) 6.1 (3.1–9.3) Outer Suburbs 8746 (8.0) 8684 (8.2) 12,911 (8.9) 8188 (8.5) 13,306 (9.1) 13,032 (10.0) 4.0 (1.5–6.6) Non-local 8617 (7.9) 7097 (6.7) 9925 (6.9) 7820 (8.1) 11,267 (7.7) 10,333 (7.9) 1.7 (−3.7–7.4) Data missing† 9091 (8.3) 4967 (4.7) 4779 (3.3) 816 (0.8) 769 (0.5) 905 (0.7) Pay