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Rural-urban differences in access to hospital obstetric and neonatal care: how far is the closest one?



To quantify drive distances to hospital obstetric services and advanced neonatal care and to examine such disparities by residential rurality and insurance type.

Study design

Data for all-payer maternal childbirth hospitalizations in 2002 (N = 661,240) and 2013 (N = 634,807) from nine geographically dispersed states were linked with the American Hospital Association annual surveys to identify maternal residence zip codes and the addresses of hospitals with obstetric services or advanced neonatal care.


The uneven geographic distribution of hospital obstetric and advanced neonatal care increased between 2002 and 2013, varying by maternal residential rurality and insurance type. Women in rural non-core areas, with Medicaid or no insurance, and living in counties with lower income and educational attainment, had to travel farther to the nearest hospital with obstetric services or neonatal care than their counterparts.


Women in communities that are already socioeconomically disadvantaged face increasing and substantial travel distances to access perinatal care.

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The authors wish to acknowledge the State Inpatient Databases, Healthcare Cost, and Utilization Project, Agency for Healthcare Research and Quality; the University of Minnesota Rural Health Research Center for data assistance.

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Correspondence to Peiyin Hung.

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The authors declare that they have no conflict of interest.

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This work was presented at the 2017 AcademyHealth Interest Groups Meeting in New Orleans, LA

Electronic supplementary material


Supplementary Table 1. Distribution of Driving Distance to Nearest Hospital Providing Obstetric Care by Maternal Characteristics in 2002 and 2013 (N=1,296,047 Women)


Supplementary Table 2. Distribution of Driving Distance to Nearest Hospital with Neonatal Intensive/Intermediate Care Capacity by Maternal Characteristics in 2002 and 2013 (N=1,296,047 Women)


Supplementary Table 3. Adjusted Marginal Effects of Residential Proximity to Nearest Hospitals Providing Obstetric Services or Advanced Neonatal Care >30 Miles Drive


Supplementary Table 4. Adjusted Marginal Effects of Residential Proximity to Nearest Hospitals Providing Obstetric Services>30 Miles Drive by Mode of Delivery

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Hung, P., Casey, M.M., Kozhimannil, K.B. et al. Rural-urban differences in access to hospital obstetric and neonatal care: how far is the closest one?. J Perinatol 38, 645–652 (2018).

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