A Spatial View of How United States Cesarean Section Rates Changed from 1990-2014

The overuse of cesarean sections (c-sections) in the United States is a contested issue. The rate of c-section births in 2015 at 32% was over double the World Health Organization recommendation of 10-15%. We employed spatial statistical methods and data visualization techniques to assess the temporal and spatial trends in c-section rates by county across the US. While the national rate of c-section remained stable at the beginning and end of this study period, an increase in rates from 1997 to 2009 was reflected simultaneously in national, state, and individual county rates. Local indicators of spatial dependence did not show spatial clustering as being connected to, or driving, the change, yet the visualization methods used here show details on individual county deviance from local temporal trends. By highlighting counties which do not follow the trends of their neighbors, we identify exceptional locations which could help further the study of the determinants of changing c-section rates in the United States.</p