Chorioamnionitis, Cesarean Deliveries, and Racial Disparities in the USA

BACKGROUNDStudies showed disparities in management and outcomes of African American when compared to Caucasian population. The presence of chorioamnionitis may affect the decision to have a cesarean delivery (CD); however, it is not known if such a decision is affected by the mothers' race/ethnicity.OBJECTIVETo assess the interaction between African American race/ethnicity and CD in women with chorioamnionitis.METHODSUtilizing the National Inpatient Sample dataset, we examined the association of CD with chorioamnionitis in the overall population and within Caucasian and African American. Logistic regression models were used to control for confounders.RESULTSThe study included 6,648,883 women who delivered 6,925,920 infants. The prevalence of chorioamnionitis was 0.78 and 1.1 in Caucasian and African American, respectively. CD with and without chorioamnionitis was 41.2% and 32.4%, respectively (aOR 1.46 (1.43-1.49), p < 0.001), in Caucasian population and 45.0% and 36.6% in African American population aOR 1.42 (1.37-1.47), p < 0.001. African American population had significantly higher CD after controlling for chorioamnionitis and other confounding variables (aOR of 1.18 (1.17-1.18), p < 0.001).CONCLUSIONChorioamnionitis is associated with increased rate of CD. Ethnic disparities exist in CD rates regardless of the chorioamnionitis status. Such findings warrant further investigation to explore factors associated with this discrepancy.