Spatial Diffusion of Elective Obstetric Interventions: A Population-Wide Study of New Jersey

Kayuet Liu , University of California, Los Angeles
Julien O. Teitler, Columbia University
Peter S. Bearman, Columbia University
Angela Clague, University of California, Los Angeles
Rayven Plaza, Columbia University
Nancy Reichman, Robert Wood Johnson Medical School

Elective delivery rates have been on the rise in the U.S. during the past three decades and have been linked to the decrease in gestational age. Long gestational age has positive effects on child health; understanding the reasons for the rising trends has public health implications. Using a unique population-wide dataset from New Jersey with information on hospital and physician identifiers, patient’s address and detailed clinical information that allows us to classify if a birth is likely to be medically unnecessary, we utilize the spatial variation in elective deliveries to study the social processes driving the demand. Preliminary analysis shows that distance to the nearest mother with a C-section increases the likelihood of an elective C-section. The effect cannot be explained by selection into neighborhoods by observed socioeconomic factors or hospital/ physician random effects. Other robustness checks will be used to examine the spatial mechanism and rule out alternative explanations.

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 Presented in Session 190. Spatial Effects on Reproductive Health and Fertility