Regional variation in caesarean section deliveries in Germany – secondary analysis of a large pharmacoepidemiological database

Background: Caesarean sections (CS) are on the increase worldwide. Causes of this increase are multifactorial and not fully understood yet. Regional variation in the percentage of CS supports the notion of local customs in the health care sector as well as preferences among women. Methods: We analysed a database consisting of claims data of four German health insurance companies for the years 2004–2006. The database (German Pharmacoepidemiological Research Database – GePaRD) includes 14 million insurants (approximately 17% of the German population) and is fairly representative in terms of sex and age distributio…