Table 6 Effects of epidemiologic and hospital factors on cesarean delivery use, logit model 1 (odds ratios)

 Age (years)

1.05^a (0.002)

1.05^a (0.002)

1.06^a (0.003)

1.06^a (0.003)

1.06^a (0.002)

1.06^a (0.002)

 Nulliparous

3.57^a (0.283)

3.57^a (0.283)

3.34^a (0.250)

3.33^a (0.250)

3.82^a (0.277)

3.81^a (0.277)

 Previous cesarean

20.60^a (1.934)

20.59^a (1.928)

21.75^a (2.560)

21.73^a (2.548)

22.06^a (2.448)

22.03^a (2.436)

 Diabetes

1.37^a (0.080)

1.37^a (0.081)

1.26^b (0.130)

1.26^b (0.130)

1.26^a (0.107)

1.26^a (0.107)

 Hypertension

1.91^a (0.116)

1.91^a (0.115)

1.67^a (0.151)

1.67^a (0.151)

1.75^a (0.176)

1.75^a (0.175)

 Eclampsia or preeclampsia

3.59^a (0.279)

3.59^a (0.280)

3.63^a (0.631)

3.63^a (0.631)

4.22^a (0.568)

4.23^a (0.570)

 Fetal growth restriction

1.80^a (0.254)

1.80^a (0.254)

2.18^a (0.529)

2.18^a (0.529)

2.10^a (0.483)

2.11^a (0.484)

 Placental bleeding

10.49^a (3.541)

10.52^a (3.545)

11.67^a (3.684)

11.73^a (3.682)

13.42^a (4.661)

13.46^a (4.657)

 Other obstetric pathology

0.98 (0.028)

0.98 (0.028)

1.08^a (0.030)

1.08^a (0.029)

1.03 (0.035)

1.03 (0.035)

 Multiple delivery

1.11 (0.187)

1.11 (0.187)

1.31 (0.242)

1.30 (0.242)

1.24 (0.230)

1.24 (0.230)

  Preterm (<  37 weeks of gestation)

1.39^a (0.143)

1.39^a (0.143)

1.37^a (0.129)

1.38^a (0.129)

1.27^b (0.155)

1.27^b (0.154)

  Post-term (>  41 weeks of gestation)

2.38^a (0.547)

2.40^a (0.549)

3.18^a (0.629)

3.19^a (0.625)

2.89^a (0.681)

2.90^a (0.679)

 Abnormal presentation (Breech or transverse)

33.19^a (4.784)

33.17^a (4.777)

33.99^a (4.554)

33.97^a (4.546)

36.40^a (6.517)

36.37^a (6.498)

 Induced labor

1.16^b (0.088)

1.16^b (0.088)

1.15^c (0.093)

1.15^c (0.093)

1.14^c (0.090)

1.14^c (0.090)

  Low birth weight (<  2500 g)

1.69^a (0.095)

1.69^a (0.095)

1.65^a (0.094)

1.65^a (0.094)

1.49^a (0.115)

1.49^a (0.114)

  High birth weight (>  4000 g)

1.95^a (0.147)

1.95^a (0.147)

2.08^a (0.190)

2.08^a (0.190)

2.07^a (0.168)

2.07^a (0.169)

 Private

1.79^b (0.419)

1.79^a (0.326)

2.21^a (0.402)

  Neonatology unit

1.26^b (0.137)

1.22^b (0.110)

1.31^a (0.124)

  Neonatal intensive care unit

1.52^b (0.318)

1.46^b (0.246)

1.65^a (0.245)

  Teaching

1.04 (0.162)

1.14 (0.140)

1.17 (0.121)

 Non-working day delivery (weekend or holiday)

0.61^a (0.029)

0.61^a (0.029)

0.59^a (0.029)

0.59^a (0.029)

0.60^a (0.032)

0.60^a (0.032)

 On-call obstetrician outside the unit

1.13 (0.105)

0.95 (0.099)

1.26^b (0.126)

1.04 (0.106)

1.17 (0.123)

0.88 (0.095)

  < 1000 deliveries per year

0.99 (0.043)

1.04 (0.050)

0.83^a (0.033)

1.02 (0.117)

1.17^a (0.044)

1.25^c (0.145)

  ≥ 2000 deliveries per year

0.93^c (0.038)

0.92^b (0.035)

0.94 (0.045)

0.93^c (0.039)

0.91^b (0.040)

0.90^a (0.034)

 Midwives (FTEs per bed)

0.87 (0.104)

0.87 (0.097)

0.89 (0.132)

0.90 (0.126)

0.88 (0.124)

0.91 (0.112)

 Obstetricians (FTEs per bed)

0.70 (0.185)

0.68^c (0.144)

0.57^c (0.183)

0.57^b (0.154)

0.69 (0.229)

0.70 (0.172)

 Anesthetists (FTEs per bed)

1.25 (0.480)

1.21 (0.386)

1.06 (0.354)

1.06 (0.257)

1.10 (0.450)

1.05 (0.296)

Prenatal care variables

Yes

Yes

No

No

Yes

Yes

Socioeconomic variables

No

No

Yes

Yes

Yes

Yes

Year fixed effects

Yes

Yes

Yes

Yes

Yes

Yes

Hospital effects

Fixed

Random

Fixed

Random

Fixed

Random

N (observations)

68,314

68,314

58,324

58,324

41,141

41,141