Sebahat HÜSEYİNOĞLU, Meral KURT DURMUŞ, Reyhan AYDIN DOĞAN
Kocaeli Üniversitesi Sağlık Bilimleri Dergisi - 2026;12(3):250-256
Objective: To examine temporal changes in cesarean birth among Turkish and foreign-national women, identify independently associated factors, and evaluate whether the associations differed by calendar year and COVID-19-era period. Methods: This retrospective cohort study included 23,127 singleton births recorded at a state hospital in Istanbul between 2017 and 2023. Annual trend analyses included 21,946 births from the complete calendar years 2018-2022. Cesarean birth was the dependent variable. Nationality, maternal age, hemoglobin level, gravida, parity, calendar year, and an operational period variable (2017-2020 vs 2021-2023) were evaluated using chi-square tests, independent-samples t tests, and multivariable binary logistic regression. Nationality-by-year and nationality-by-period interactions were examined. Complete-case analysis was used. Results: Overall cesarean birth rates were 44.5% in 2018, 45.1% in 2019, 43.5% in 2020, 48.0% in 2021, and 47.1% in 2022 (p<0.001). The odds of cesarean birth increased modestly over time (OR=1.03; 95% CI, 1.01-1.05). Foreign nationality was associated with lower odds of cesarean birth (aOR=0.71; 95% CI, 0.66-0.75), whereas maternal age and gravida were associated with higher odds. Hemoglobin level and parity were inversely associated with cesarean birth. The later COVID-19-era period was associated with higher odds (aOR=1.17; 95% CI, 1.10-1.24). Nationality-by-year and nationality-by-period interactions were significant. Conclusion: Cesarean birth was common and increased over time. Although foreign-national women generally had lower adjusted odds, the difference between nationality groups narrowed by 2022, indicating that nationality-related disparities varied across calendar periods.
