Cesarean Delivery and Healthcare Utilization and Costs in the Offspring: A Retrospective Cohort Study

Abstract

Objective: To examine the association between Caesarean section (CS) and health care utilization and costs in offspring from birth until age 7 years. Methods: A retrospective cohort study of singleton term births in the Canadian province of Nova Scotia between 2003 and 2007 followed until age seven years was conducted using data from the Nova Scotia Atlee Perinatal Database and administrative health data. The main exposure was mode of delivery (CS vs. vaginal birth (VB)); the outcome was health care utilization and costs during the first seven years of life. Associations were modeled using multiple regression adjusting for maternal pre- pregnancy weight and socio-demographic factors. Results: 32,464 births were included in the analysis. Compared to VB children, children born by CS had more physician visits (incidence rate ratio [IRR] 1.06, 95% confidence interval [CI] 1.05-1.08) and longer hospital stays (IRR 1.12, 95% CI 1.03-1.21) and were more likely to be high utilizers of physician visits (odds ratio 1.23, 95% CI 1.10-1.37). Physician and hospital costs were $775 higher for children born by CS compared to VB. Conclusion: CS compared to VB is associated with small but statistically significant increases in health care utilization and costs in during the first seven years of life.