Effects of rurality and distance to care on perinatal outcomes over a 1-year period during the COVID-19 pandemic

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2023-12-27 DOI:10.1111/jrh.12820

Pratyusha V. Bujimalla MS, Kimberly A. Kenne MD, MCR, Haley A. Steffen BA, Samantha R. Swartz MD, Linder H. Wendt MS, Adam M. Skibbe MLA, J. Brooks Jackson MD, MBA, Mary B. Rysavy MD

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Abstract

Purpose

Our aim was to investigate the roles of rurality and distance to care on adverse perinatal outcomes and COVID-19 seroprevalence at the time of delivery over a 1-year period.

Methods

Data were collected from the electronic medical record on all pregnant patients who delivered at a single, large, Midwest academic medical center over 1 year. Rurality was classified using standard Rural-Urban Commuting Area codes. Geographic Information System tools were used to map outcomes. Data were analyzed with univariate and multivariate models, controlling for Body Mass Index (BMI), insurance status, and parity.

Findings

A total of 2,497 patients delivered during the study period; 20% of patients were rural (n = 499), 18.6% were micropolitan (n = 466), and 61.4% were metropolitan (n = 1,532). 10.4% of patients (n = 259) were COVID-19 seropositive. Rural patients did not experience higher rates of any measured adverse outcomes than metropolitan patients; micropolitan patients had increased odds of preterm labor (OR = 1.41, P = .022) and pre-eclampsia (OR = 1.78, P<.001). Patients living 30+ miles away from the medical center had increased odds of preterm labor (OR = 1.94, P<.001), pre-eclampsia (OR = 1.73, P = .002), and infant admission to the neonatal intensive care unit (OR = 2.12, P<.001), as well as lower gestational age at delivery (β = −9.2 days, P<.001) and birth weight (β = −206 grams, P<.001).

Conclusion

Distance to care, rather than rurality, was the key predictor of multiple adverse perinatal outcomes in this cohort of deliveries over a 1-year period. Our study suggests that rurality should not be used as a standalone indicator of access to care without further knowledge of the specific barriers affecting a given population.

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在 COVID-19 大流行期间，农村地区和就医距离对围产期结果的影响。

目的：我们的目的是研究农村地区和就医距离对围产期不良结局和分娩时 COVID-19 血清流行率的影响：方法：我们从电子病历中收集了一年来在中西部一家大型学术医疗中心分娩的所有孕妇的数据。使用标准的农村-城市通勤区代码对农村地区进行分类。使用地理信息系统工具绘制结果图。数据通过单变量和多变量模型进行分析，并对体重指数（BMI）、保险状况和奇偶性进行了控制：在研究期间，共有 2497 名患者进行了分娩；20% 的患者在农村（n = 499），18.6% 的患者在小城市（n = 466），61.4% 的患者在大都市（n = 1532）。10.4%的患者（n = 259）COVID-19血清反应呈阳性。与大都市患者相比，农村患者的任何不良后果发生率都不高；大都市患者发生早产（OR = 1.41，P = .022）和子痫前期（OR = 1.78，PC结论）的几率增加：在这个为期一年的分娩队列中，预测多种不良围产期结局的关键因素是就医距离，而非居住地。我们的研究表明，在没有进一步了解影响特定人群的具体障碍的情况下，不应将乡镇作为获得医疗服务的独立指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.