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Associations between maternal residential rurality and maternal health, access to care, and very low birthweight infant outcomes

Journal of Perinatology volume 42, pages 1592–1599 (2022)Cite this article

Subjects

Abstract

Objective

Infant mortality is increased in isolated rural areas. This study compares prenatal factors, access to care, and health outcomes for very-low birthweight (VLBW) infants by degree of maternal residential rurality.

Methods

This descriptive population-based retrospective cohort study used the California Perinatal Quality Care Collaborative registry to study VLBW infants. Rurality was assigned as urban, large rural, and small rural/isolated using the Rural Urban Commuting Area codes. We used hierarchical random effect models to test the association of rurality with survival without major morbidity.

Results

The study included 38 614 dyads. VLBW survival without major morbidity decreased with increasing rurality and the relationship remained significant for small rural/isolated areas (OR 0.79, p = 0.03) after adjustment. Birth weight, gestational age, and infant sex were similar across geographic groups.

Conclusion

A rural urban disparity exists for VLBW survival without major morbidity. Our findings generate hypotheses about factors that may be driving these disparities.

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Data availability

The majority of the data generated or analyzed during this study are included in this published article and the variables used are included in the Appendix. The additional datasets generated during and/or analyzed during the current study are not publicly available due to the California Perinatal Quality Care Collaborative agreements, however, they are available from the corresponding author on reasonable request.

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Funding

Funding was awarded by the Pratt Foundation.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA

    Devlynne S. Ondusko & Emily Hawkins Carter

  2. Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA, USA

    Jessica Liu & Jochen Profit

  3. California Perinatal Quality Care Collaborative, Palo Alto, CA, USA

    Jessica Liu & Jochen Profit

  4. Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA

    Brigit Hatch

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  1. Devlynne S. Ondusko
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  2. Jessica Liu
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  3. Brigit Hatch
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  4. Jochen Profit
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  5. Emily Hawkins Carter
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Contributions

All authors (DSO, JL, JP, BH, EHC) made substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data. DSO drafted the work, all authors revised it critically for important intellectual content. All authors approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Devlynne S. Ondusko.

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Ondusko, D.S., Liu, J., Hatch, B. et al. Associations between maternal residential rurality and maternal health, access to care, and very low birthweight infant outcomes. J Perinatol 42, 1592–1599 (2022). https://doi.org/10.1038/s41372-022-01456-9

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