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

Journal of Perinatology volume 42, pages 1600–1606 (2022)Cite this article

Subjects

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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Fig. 1: Unadjusted and adjusted odds of adverse perinatal outcomes by hospital-serving status.

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Data availability

Data generated and analyzed during the current study are not publicly available due to data use agreements, but may be available from the senior author on reasonable request.

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Author information

Authors and Affiliations

  1. Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Sara C. Handley, Molly Passarella & Scott A. Lorch

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Sara C. Handley & Scott A. Lorch

  3. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Sara C. Handley & Scott A. Lorch

  4. Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN, USA

    Julia D. Interrante & Katy B. Kozhimannil

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  1. Sara C. Handley
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  2. Molly Passarella
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  4. Katy B. Kozhimannil
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  5. Scott A. Lorch
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Contributions

SCH conceptualized and designed the study, interpreted the data, and drafted the manuscript. MP completed the data analysis, interpreted the data, and critically revised the manuscript. JDI interpreted the data and critically revised the manuscript. KBK participated in the design of the study, interpretation of the data, and critically revised the manuscript. SAL contributed to study conceptualization, interpretation of the data, and critically revised the manuscript.

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Correspondence to Sara C. Handley.

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Handley, S.C., Passarella, M., Interrante, J.D. et al. Perinatal outcomes for rural obstetric patients and neonates in rural-located and metropolitan-located hospitals. J Perinatol 42, 1600–1606 (2022). https://doi.org/10.1038/s41372-022-01490-7

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