In States That Border Mexico, Cesarean Rates Were Highest For Hispanic Women Living In Border Counties In 2015.

Hispanic women living on the US-Mexico border have had higher cesarean delivery rates than other Hispanic women in the US. Using birth certificate and other data, we compared cesarean rates among Hispanic women living in US border counties with rates among other Hispanic women in border states during 2015. Using linear regression, we also determined which medical, hospital, and sociodemographic characteristics accounted for intercounty variations in rates. In border counties the rates were 38.3 percent for all births, 31.3 percent for low-risk nulliparous mothers, 21.0 percent for primary cesareans, and 94.7 percent for repeat cesareans. In nonborder counties the rates were 30.9 percent, 24.4 percent, 15.1 percent, and 90.5 percent, respectively. Maternal medical characteristics explained over 50 percent of the variation for all cesarean outcomes. Other characteristics that were major contributors to higher cesarean rates included for-profit hospital status, delivery by a physician as opposed to a midwife, and residence in a county with a larger Hispanic fraction of the population. Addressing potentially unnecessary cesareans among Hispanic women on the border will likely require a multicomponent strategy.

Trends in Hispanic and non-Hispanic white cesarean delivery rates on the US-Mexico border, 2000-2015.

BACKGROUND: Cesarean delivery occurs in one in three US births and poses risks for mothers and infants. Hispanic cesarean rates were higher than non-Hispanic white rates in the US in 2016. In 2009, cesarean rates among Hispanics on the US-Mexico border exceeded rates among US Hispanics. Since 2009, rates have declined nationwide, but border Hispanic rates have not been studied. OBJECTIVE: To compare cesarean delivery rates and trends in Hispanics and non-Hispanic whites in border and nonborder counties of the four US border states before and after 2009. STUDY DESIGN: We used data from birth certificates to calculate percentages of cesarean deliveries among all births and births to low-risk nulliparous women during 2000-2015, and among births to low-risk women with and without a previous cesarean during 2009-2015. We calculated 95% confidence intervals around rates and used regular and piecewise linear regression to estimate trends for four ethnic-geographic subpopulations defined by combinations of Hispanic ethnicity and border-nonborder status. RESULTS: Of the four subpopulations, border Hispanic rates were highest every year for all cesarean outcomes. In 2015 they were 38.3% overall, 31.4% among low-risk nulliparous women, and 21.1% and 94.6% among low-risk women without and with a previous cesarean, respectively. Nonborder Hispanic rates in 2015 were lowest for all outcomes but repeat cesarean. Rates for all four subpopulations rose steadily during 2000-2009. Unlike rates for non-Hispanic whites, border and nonborder Hispanic rates did not decline post-2009. Most of the border Hispanic excess can be attributed to higher cesarean rates in Texas. DISCUSSION: Border Hispanic cesarean rates remain higher than those among other Hispanics and non-Hispanic whites in border states and show no signs of declining. This continuing disparity warrants further analysis using individual as well as hospital, environmental and other contextual factors to help target prevention measures.

Pyrosequencing estimates of the diversity of antibiotic resistant bacteria in a wastewater system.

Standard protocols for monitoring wastewater treatment efficacy target Escherichia coli and fecal coliforms. This might not accurately describe risks associated with antibiotic resistance in the bacterial population of treated wastewaters. We modified a standard agar recovery method by amending it with various antibiotics. The resulting bacterial colonies were submitted to 454 pyrosequencing; thus we identified the diversity of culturable antibiotic resistant bacteria from treated and raw wastewaters. This approach produced 209,706 high quality reads of >300 bp. Operational taxonomic units (OTUs) within Proteobacteria dominated the system. The Shannon-Wiener H' index showed bacterial populations recovered on ciprofloxacin amended agars to be the least diverse. Principal component analysis of OTU distribution at phylum level showed that Proteobacteria accounted for most of the variability. The same analysis revealed most of the samples to have similar diversities at phylum level being dominated by Proteobacteria, though a few samples, typically recovered from ciprofloxacin or doxycycline amended agars were often dissimilar. Arcobacter spp. or E. coli were dominant in the bacterial communities recovered on agars amended with ciprofloxacin or doxycycline, respectively. Genera containing putative pathogens were mostly representatives of Gamma and Epsilon proteobacteria. Bacterial populations containing multiple antibiotic resistance (MAR) in the final treated effluent was a possibility.