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Observational Study
. 2022 Dec;42(12):1600-1606.
doi: 10.1038/s41372-022-01490-7. Epub 2022 Aug 13.

Perinatal outcomes for rural obstetric patients and neonates in rural-located and metropolitan-located hospitals

Sara C Handley  1   2   3 , Molly Passarella  4 , Julia D Interrante  5 , Katy B Kozhimannil  5 , Scott A Lorch  4   6   7
Affiliations
Observational Study

Perinatal outcomes for rural obstetric patients and neonates in rural-located and metropolitan-located hospitals

Sara C Handley et al. J Perinatol. 2022 Dec.

Abstract

Objective: To compare rural obstetric patient and neonate characteristics and outcomes by birth location.

Methods: Retrospective observational cohort study of rural residents' hospital births from California, Pennsylvania, and South Carolina. Hospitals in rural counties were rural-located, those in metropolitan counties with ≥10% of obstetric patients from rural communities were rural-serving, metropolitan-located, others were non-rural-serving, metropolitan-located. Any adverse obstetric patient or neonatal outcomes were assessed with logistic regression accounting for patient characteristics, state, year, and hospital.

Results: Of 466,896 rural patient births, 64.3% occurred in rural-located, 22.5% in rural-serving, metropolitan-located, and 13.1% in non-rural-serving, metropolitan-located hospitals. The odds of any adverse outcome increased in rural-serving (aOR 1.27, 95% CI 1.10-1.46) and non-rural-serving (aOR 1.35, 95% CI 1.18-1.55) metropolitan-located hospitals.

Conclusion: One-third of rural obstetric patients received care in metropolitan-located hospitals. These patients have higher comorbidity rates and higher odds of adverse outcomes likely reflecting referral for higher baseline illness severity.

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References

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