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Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China, 2008-2014

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Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China, 2008-2014 Supplementary Online Content Li H-T, Luo S, Trasande L, et al. Geographic variations and temporal trends in cesarean delivery rates in China, 2008-2014. JAMA. doi:10.1001/jama.2016.18663 eTable 1. Cesarean delivery rate in 2010 for the 94 counties that participated in the China’s National Health Service Survey eTable 2. Local cesarean rates for hospitals that participated in the 2008 WHO survey eTable 3. Cesarean delivery rate in 31 provinces of mainland China, 2008-2014 eTable 4. Cesarean delivery rates in 17 supercities, 2008-2014 eTable 5. Hypothetical cesarean rates in 31 provinces of total population during 2008-2014, assuming that non-resident women have the same delivery pattern as resident women eTable 6. Hypothetical cesarean rates in 31 provinces of total population during 2008-2014, assuming that non-resident women have a one-third lower cesarean rate than resident women eFigure. Funnel plots for county cesarean rates, 2008 and 2014 eReferences This supplementary material has been provided by the authors to give readers additional information about their work. © 2017 American Medical Association. All rights reserved. Downloaded From: https://edhub.ama-assn.org/ on 09/24/2021 eTable 1. Cesarean delivery rate in 2010 for the 94 counties that participated in the China’s National Health Service Survey County name Total live births Cesarean births in County-level cesarean in NHSS data NHSS data rate in the NMCHS data (%)* Dongcheng district 4155 2338 56.3 Miyun county 2691 1518 56.4 Hebei district 3560 2549 71.6 Ji county 9464 5863 62.0 Lubei district 4575 2826 61.8 Wu’an county 10965 1064 9.7 Tang county 8465 3701 43.7 Fengning county 3898 945 24.2 Pingding county 2612 602 23.0 Wuxiang county 1925 336 17.5 Yangcheng county 2213 306 13.8 Kalaqin county 3103 869 28.0 Kailu county 3196 2414 75.5 Zhungeer county 2991 999 33.4 Dadong district 5111 3561 69.7 Dengta county 3411 2806 82.3 Tiedong district 1676 1108 66.1 Dongfeng county 2994 2189 73.1 Yanji county 4547 3134 68.9 Fuyu county 2531 1277 50.5 Baoqing county 2964 1402 47.3 Beilin district 6113 3432 56.1 Luwan district 2268 1833 80.8 Chongming county 2587 2005 77.5 Pizhou county 28329 9182 32.4 Jinhu county 2049 1370 66.9 Yangzhong county 1580 1467 92.8 Shangcheng county 2579 1477 57.3 Tonglu county 2500 1385 55.4 Tongxiang county 4439 2943 66.3 Guzhen county 7841 1296 16.5 Daguan district 1526 359 23.5 Lujiang county 11755 3129 26.6 Mengcheng county 15051 3662 24.3 Ninghua county 4657 752 16.1 © 2017 American Medical Association. All rights reserved. Downloaded From: https://edhub.ama-assn.org/ on 09/24/2021 Jianyang county 3847 1167 30.3 Yongding county 6321 1906 30.2 Yuanzhou district 11542 3868 33.5 Shanggao county 4528 1029 22.7 Gaoan county 11253 2594 23.1 Shibei district 4982 2757 55.3 Zhaoyuan county 3588 1386 38.6 Liangshan county 7886 2351 29.8 Yucheng county 6336 3113 49.1 Ruyang county 8957 2159 24.1 Weibin district 625 291 46.6 Sui county 12700 2761 21.7 Fugou county 8706 2562 29.4 Laohekou county 5821 2192 37.7 Macheng county 10426 3576 34.3 Hefeng county 2277 996 43.7 Tianxin district 3555 2084 58.6 Anxiang county 5085 2025 39.8 Cili county 6361 1803 28.3 Anren county 5979 1312 21.9 Qiewan district 2977 1424 47.8 Sihui county 4842 1634 33.7 Yingde county 12564 2552 20.3 Zhongshan county 30716 8866 28.9 Binyang county 12849 2539 19.8 Hepu county 15269 2110 13.8 Luocheng county 5330 781 14.7 Wenchang county 6892 1400 20.3 Wanzhou district 14354 5955 41.5 Shapingba district 4975 2867 57.6 Zhong county 7813 2607 33.4 Qingyang district 4368 3146 72.0 Yanting county 3727 1275 34.2 Langzhong county 5092 2095 41.1 Yuping county 1822 429 23.5 Shibing county 1631 201 12.3 Wuhua district 9767 5295 54.2 Guangnan county 11473 524 4.6 Xiangyun 4336 1274 29.4 Chengguan district 510 81 15.9 Mozhugongka county 746 10 1.3 © 2017 American Medical Association. All rights reserved. Downloaded From: https://edhub.ama-assn.org/ on 09/24/2021 Jintai district 2198 809 36.8 Mei county 3303 702 21.3 Hanyin county 3157 492 15.6 Yuzhong county 3911 732 18.7 Jingtai county 2366 291 12.3 Lintan county 1977 133 6.7 Huzhu county 4758 265 5.6 Haiyan county 372 46 12.4 Xixia district 1362 531 39.0 Longde county 1812 264 14.6 Zhongning county 4009 712 17.8 Tianshan district 7818 4314 55.2 Hetian county 6415 232 3.6 Meitan county 4806 1525 31.7 Xinyuan county 5039 999 19.8 Jinchang district# - - 51.5 Xiling district# - - 77.2 Longhua district# - - 16.6 Arithmetic mean of 94 county-level - - 37.3 cesarean rates from the NMCHS data *China’s National Health Services Study (NHSS) uses a multistage cluster sampling method. For the 2011 NHSS (eReference 1) covering the years 2009-2011, 94 nationally representative counties were sampled. In each county, five townships were selected within which two villages were selected, and 20 households were selected in each village. In other words, the number of households sampled was the same in every county, regardless of the county’s population. The reported national NHSS cesarean rate was calculated as the total number of cesareans in the 94 counties/total births in the 94 counties *100%, which is the arithmetic mean of cesarean rates in the 94 counties. For this exhibit we attempted to replicate the NHSS approach by extracting the cesarean rate in the NMCHS data for each of the 94 counties in 2010 (the midpoint year of the survey period) and “assigning” that rate to each county. We report the arithmetic mean of the 94 cesarean rates in the NMCHS data, which is Sum i = 1 to 94 [(NMCHS CS ratei)]/94, th where NMCHSCS ratei= the NMCHS CS rate for the i county. #For cities that include multiple counties for which rates are reported at the city-level in the NMCHS, we used the cesarean rate for the city as an approximation of the rate for the sampled county. © 2017 American Medical Association. All rights reserved. Downloaded From: https://edhub.ama-assn.org/ on 09/24/2021 eTable 2. Local cesarean rates for hospitals that participated in the 2008 WHO survey* Province Hospital name Hospital Cesarean rate in the NMCHS location data for this location (%) Beijing Capital Medical University Xuanwu Hospital Xicheng district 59.2 Capital Medical University Friendship Hospital Xicheng district 59.2 Fengtai Nanyuan Hospital Fengtai district 60.3 Qiaonan Department of Fengtai Hospital Fengtai district 60.3 Capital Medical University You’an Hospital Fengtai district 60.3 Qiaobei Department of Fengtai Hospital Fengtai district 60.3 Pinggu Hospital Pinggu district 54.2 Zhejiang Ningbo Women and Children Hospital Ningbo city 61.4 Xiangshan County Red Cross Hospital Xiangshan 55.5 county Ruian Maternal and Child Health Hospital Ruian county 42.4 Ruian People’s Hospital Ruian county 42.4 Ou’hai Third people’s Hospital Ou‘hai county 37.5 Ruian Tangxia Center Hospital Ruian county 42.4 Haining Maternal and Child Health Hospital Haining county 69.2 Yunnan Yunnan Obstetrics and Gynecology Hospital Kunming city 36.6 Kunming Oriental Hospital Kunming city 36.6 Yunnan Ping’an Chinese and Western Medicine Kunming city 36.6 Hospital Yunnan Second People’s Hospital Kunming city 36.6 Jianshui County People’s Hospital Jianshui 20.5 county Xiangyun County People’s Hospital Xiangyun 23.5 county Heqing County Maternal and Child Health Heqing county 22.5 Hospital Arithmetic mean of -- -- 46.5 21 cesarean rates from the NMCHS data *The WHO global survey (eReference 2) “aimed to estimate the rate of different methods of delivery and to examine the relation between method of delivery and maternal and © 2017 American Medical Association. All rights reserved. Downloaded From: https://edhub.ama-assn.org/ on 09/24/2021 perinatal outcomes in selected facilities …”. In each country, the sampling strategy was to sample the capital city, and in addition to randomly select (by computer) two regions or provinces, with the probability of selection proportional to size. In China, this resulted in the selection of Beijing, Zhejiang and Yunnan, and the drawing of a sample of 21 hospitals, as described in detail in eReference 2. While the total number of deliveries may have varied across the 21 sampled hospitals, there is to our knowledge no published information about this: the WHO’s reported national rate for China in eReference 2 is the total number of cesareans in the 21 hospitals/total births in the 21 hospitals *100%. Because we did not have the number of deliveries in each hospital to use as weights, for this analysis, for each hospital, we assigned the NMCHS cesarean rate from the hospital’s location (district, city or county). We took the arithmetic mean of those 21 cesarean rates from the NMCHS data. Since there were 21 hospitals, this was Sum i = 1 to 21[(NMCHS th CSratei)]/21], where NMCHS CSratei = the NMCHS cesarean rate for i hospital’s location. © 2017 American Medical Association. All rights reserved. Downloaded From: https://edhub.ama-assn.org/ on 09/24/2021 eTable 3. Cesarean delivery rate in 31 provinces of mainland China, 2008-2014 Province The total number of live births (cesarean rate, %) Total 2008 2009 2010 2011 2012 2013 2014 births (cesarean rate, %) North: Beijing 82305 86597 84164 100619 121747 117693 142707 735832 (59.2) (60.1) (59.2) (53.6) (50.6) (48.9) (43.2) (52.4) Tianjin 79368 83289 83035 88521 97656 91172 96944 619985 (68.4) (71.5) (67.9) (60.5) (60.9) (62.3) (57.8) (63.9) Hebei 835441 931930 946713 1004393 1050860 999938 995618 6764893 (33.8) (35.5) (37.1) (38.8) (38.4) (39.0) (38.7) (37.4) Shanxi 317210 331104 336740 338039 351114 346126 361575 2381908 (16.0) (17.6)
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