Caesarean section rates and peripartum outcomes
- 4 minsI recently saw an interesting Tweet which got me to thinking what the associations were between Caesarean section rates in different countries and maternal and baby outcomes:
Instead of "experts say" can we have "evidence suggests" please? (With links to high quality evidence.) https://t.co/X2K3XQ03ib
— Steven Shorrock (@StevenShorrock) April 13, 2018
So I went away and looked for the OECD data which might help with looking at this question. I found 2 sources from the OECD website, one for the Caesarean section rates and another for the outcomes. I used the 2015 data (the most recent available).
#Load the required packages
library(tidyverse)
library(readr)
library(ggrepel)
#Load the data
Caesarean_rates <- read_csv("../data/DP_LIVE_13042018135921941.csv")
Outcomes <- read_csv("../data/HEALTH_STAT_13042018135958973.csv")
#Join the two sources
Caesarean_rates <- Caesarean_rates %>% filter(TIME == 2015) %>%
select(LOCATION, TIME, Caesarean_rate = Value)
Outcomes <- Outcomes %>% filter(Year == 2015, VAR != "MATINETW", VAR != "MATIINTW") %>%
select(COU, VAR, Country, Variable, Year, Outcome_Value = "Value") %>%
#rename the variables into something more understandable
mutate(VAR = recode(VAR, `MATIINFA` = "Infant mortality",
`MATIMATM` = "Maternal mortality",
`MATINEON` = "Neonatal mortality",
`MATIPERI` = "Perinatal mortality"))
Combined <- left_join(Outcomes, Caesarean_rates, by = c(COU = "LOCATION"))
#Plot the data
ggplot(data = Combined , aes(x = Caesarean_rate, y = Outcome_Value)) +
geom_point() +
geom_smooth(method = "lm") +
geom_text_repel(aes(label = Country)) +
facet_wrap(~ VAR, nrow = 2) +
labs(x = "Caesarean sections (per 1,000 live births)",
y = "Deaths (per 1,000 live births)") +
theme_light()
So it seems that all outcomes are worse in countries with higher Caesarean section rates. Of course this is not causal. But it’s an interesting association. Also Latvia seems to have a huge maternal mortality compared to all the other OECD countries, and is not an outlier for baby deaths. I wonder what that’s all about.
sessionInfo()## R version 3.4.2 (2017-09-28)
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Danny Wong
Anaesthetist & Health Services Researcher