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. 2014 Jan;52(1):4-9.
doi: 10.1097/MLR.0000000000000016.

Rural-urban differences in obstetric care, 2002-2010, and implications for the future

Katy B Kozhimannil  1 , Peiyin Hung, Shailendra Prasad, Michelle Casey, Ira Moscovice
Affiliations

Rural-urban differences in obstetric care, 2002-2010, and implications for the future

Katy B Kozhimannil et al. Med Care. 2014 Jan.

Abstract

Background: Approximately 15% of the 4 million annual US births occur in rural hospitals.

Objective: To (1) measure differences in obstetric care in rural and urban hospitals, and to (2) examine whether trends over time differ by rural-urban hospital location.

Research design and subjects: This was a retrospective analysis of hospital discharge records for all births in the 2002-2010 Nationwide Inpatient Sample, which constitutes 20% sample of US hospitals (N = 7,188,972 births: 6,316,743 in urban hospitals, 837,772 in rural hospitals).

Measures: Rates of low-risk cesarean (full-term, singleton, vertex pregnancies; no prior cesarean), vaginal birth after cesarean (VBAC), nonindicated cesarean, and nonindicated labor induction were estimated.

Results: In 2010, low-risk cesarean rates in rural and urban hospitals were 15.5% and 16.1%, respectively, and nonindicated cesarean rates were 16.9% and 17.8%, respectively. VBAC rates were 5.0% in rural and 10.0% in urban hospitals in 2010. Between 2002 and 2010, rates of low-risk cesarean and nonindicated cesarean increased, and VBAC rates decreased in both rural and urban hospitals. Nonindicated labor induction was less frequent in rural versus urban hospitals in 2002 [adjusted odds ratio = 0.79 (0.78-0.81)], but increased more rapidly in rural hospitals from 2002 to 2010 [adjusted odds ratio = 1.05 (1.05-1.06)]. In 2010, 16.5% of rural births were induced without indication (12.0% of urban births).

Conclusions: From 2002 to 2010, cesarean rates rose and VBAC rates fell in both rural and urban hospitals. Nonindicated labor induction rates rose disproportionately faster in rural versus urban settings. Tailored clinical and policy tools are required to address differences between rural and urban hospitals.

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Figures

Figure 1
Figure 1
Predicted Probability of Labor Induction For A Low-Risk Woman With Average Characteristics And No Medical Indication For The Procedure (Age 28, White, Private Insurance, No Complications) by Hospital Geographic Location, Over Time (2002-2010). Note: Predicted probabilities were calculated using coefficients generating using the model presented in Table 3.
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