Márquez-Calderón, SoledadRuiz-Ramos, MiguelJuárez, SolLibrero López, Julián2012-07-302012-07-302011-03Márquez-Calderón S, Ruiz-Ramos M, Juárez S, Librero López J. [Caesarean delivery in Andalusia, Spain: relationship with social, clinical and health services factors (2007-2009)]. Rev. Esp. Salud Publica; 85(2):205-151135-5727http://hdl.handle.net/10668/432Fundamento: La tendencia creciente y variabilidad geográ­fica en el uso de la cesárea sugiere la existencia de factores explicativos no clínicos. El objetivo del estudio es analizar el uso de las cesáreas en Andalucía, explorando el papel de varia­bles sociales, clínicas y de los servicios sanitarios. Métodos: Estudio transversal de todos los nacimientos de Andalucía (2007-2009) utilizando como fuente de información el Movimiento Natural de la Población. La variable dependien­te fue la frecuencia de cesáreas y las explicativas se clasificaron en tres grupos: con significado clínico, relacionadas con el fun­cionamiento de los servicios sanitarios, y con significado social. Se realizó una regresión logística multivariante. Resultados: El 24,8% de los 293.558 nacimientos fue por cesárea. En el análisis multivariante se observó que la variable clínica con la mayor odds ratio (OR) fue la existencia de com­plicaciones (OR=19,36). En cuanto a las variables relacionadas con los servicios sanitarios hubo un 55% más cesáreas de lunes a viernes que en fines de semana y la provincia con mayor uso de cesárea fue Cádiz (OR de 1,21 frente a Almería) con una razón de partos en centros públicos frente a privados de 3,7. La frecuencia de cesáreas fue un 34% superior en las mujeres con estudios de tercer grado que en las que no tenían estudios. Conclusiones: La variable con mayor influencia en la prác­tica de cesárea fue la existencia de complicaciones. La tasa de cesárea estuvo por encima de los estándares aceptados en todas las clases sociales, con mayor incidencia a mayor nivel educati­vo. Las diferencias interprovinciales reflejan distintos patrones de uso de la medicina privadaBACKGROUND Increasing trend and geographical variations in the use of caesarean section suggest the influence of non-clinical factors. The objective was to describe the use of caesarean section in the Andalusian region in Spain by exploring the role of social, clinical, and health services variables. METHODS A cross-sectional study was carried out using vital statistics. It involves all births occurred in Andalusia during the period of 2007-2009. The dependent variable was the use of caesarean section and the set of covariates were classified into three groups: those with a clinical meaning, those related to the health services organization, and those with a social significance. Multivariate logistic regressions were used. RESULTS In the data set of 293,558 births, the prevalence of caesarean delivery was 24.8%. The multivariate analysis highlights the labour complications as the clinical variable with the highest odds ratio (OR=19.36). Regarding the health services variables, the odds of experiencing a caesarean delivery were 55% higher on weekdays than on weekends. Cádiz was the province with the highest OR for caesarean section (comparison between Cádiz and Almería: OR=1,21) where the ratio between births in public and private hospitals was 3.7. The frequency of caesarean section was 34% higher in women with third level education than those with no education. CONCLUSIONS Labour complication is the most influential variable for caesarean section. Caesarean birth rate is above the accepted standards for all social classes and increases with educational level. Inter-provincial differences reflect different patterns with regard to the use of private medicine.esCesáreaCalidad de la atención de salud, acceso y evaluaciónDesigualdades en la saludHealth care quality, access and evaluationHealth social inequalitiesMedical Subject Headings::Health Care::Environment and Public Health::Public Health::Epidemiologic Factors::Age FactorsMedical Subject Headings::Information Science::Information Science::Data Collection::Records as Topic::Birth CertificatesMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Obstetric Surgical Procedures::Delivery, Obstetric::Cesarean SectionMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cross-Sectional StudiesMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Delivery of Health CareMedical Subject Headings::Health Care::Population Characteristics::Socioeconomic Factors::Educational StatusMedical Subject Headings::Check Tags::FemaleMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Delivery of Health Care::Healthcare DisparitiesMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Named Groups::Persons::Age Groups::Infant::Infant, NewbornMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Statistics as Topic::Regression Analysis::Logistic ModelsMedical Subject Headings::Check Tags::MaleMedical Subject Headings::Diseases::Female Urogenital Diseases and Pregnancy Complications::Pregnancy Complications::Obstetric Labor ComplicationsMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Statistics as Topic::Probability::Odds RatioMedical Subject Headings::Phenomena and Processes::Reproductive and Urinary Physiological Phenomena::Reproductive Physiological Phenomena::Reproductive Physiological Processes::Reproduction::PregnancyMedical Subject Headings::Geographicals::Geographic Locations::Europe::SpainMedical Subject Headings::Phenomena and Processes::Physical Phenomena::Time::Time FactorsMedical Subject Headings::Named Groups::Persons::Age Groups::Adultresearch article21826382open access10.1590/S1135-572720110002000082173-9110