Effects of factors influencing cesarean section rates between 2008 and 2018 in Taiwan: A population-based cross-sectional study

Many factors can affect delivery mode decisions. Therefore, this study aimed to explore the effects of maternal age, physician's sex, region, income, and hospital type on cesarean section (C/S) delivery rates between 2008 and 2018 in Taiwan. In this population-based cross-sectional study, data were extracted from the Taiwan National Health Insurance Research Database (2 million individuals). The logistic regression method was used to analyze the aforementioned risk factors, and data are expressed as odds ratios (ORs) and 95% confidence intervals. In total, 9826 and 9714 deliveries in 2008 and 2018, respectively, were included in the analysis. The C/S ratio increased from 16.5% (n = 1607) in 2008 to 19.7% (n = 1916) in 2018. A higher C/S risk for women aged >34 years (ORs: 2.835 and 2.225 in 2008 and 2018, respectively) than for those aged ≤34 years was noted in both years. Female physicians had a lower risk of performing C/S than male physicians in 2008 (OR: .762, 95% confidence interval: .625-.928), but this was not apparent in 2018. Higher income levels (>new Taiwan dollar 45,081) and central Taiwan were associated with a lower C/S risk in both years. Private, not-for-profit hospitals had a lower C/S risk in 2008, which was not apparent in 2018. In conclusion, this study revealed a significant increase in C/S rates over the past decade, which was influenced by multiple factors. Maternal age, physician's sex, income status, location, and type of hospital may influence C/S rates. Analyzing these relationships can inform the development of strategies aimed at reducing future C/S rates, and targeted interventions may reduce the C/S rates.