*Division of Health Policy and Management, University of Minnesota School of Public Health †Division of Health Policy and Management, University of Minnesota Rural Health Research Center ‡Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN.
Med Care. 2014 Jan;52(1):4-9. doi: 10.1097/MLR.0000000000000016.
Approximately 15% of the 4 million annual US births occur in rural hospitals.
To (1) measure differences in obstetric care in rural and urban hospitals, and to (2) examine whether trends over time differ by rural-urban hospital location.
This was a retrospective analysis of hospital discharge records for all births in the 2002-2010 Nationwide Inpatient Sample, which constitutes 20% sample of US hospitals (N = 7,188,972 births: 6,316,743 in urban hospitals, 837,772 in rural hospitals).
Rates of low-risk cesarean (full-term, singleton, vertex pregnancies; no prior cesarean), vaginal birth after cesarean (VBAC), nonindicated cesarean, and nonindicated labor induction were estimated.
In 2010, low-risk cesarean rates in rural and urban hospitals were 15.5% and 16.1%, respectively, and nonindicated cesarean rates were 16.9% and 17.8%, respectively. VBAC rates were 5.0% in rural and 10.0% in urban hospitals in 2010. Between 2002 and 2010, rates of low-risk cesarean and nonindicated cesarean increased, and VBAC rates decreased in both rural and urban hospitals. Nonindicated labor induction was less frequent in rural versus urban hospitals in 2002 [adjusted odds ratio = 0.79 (0.78-0.81)], but increased more rapidly in rural hospitals from 2002 to 2010 [adjusted odds ratio = 1.05 (1.05-1.06)]. In 2010, 16.5% of rural births were induced without indication (12.0% of urban births).
From 2002 to 2010, cesarean rates rose and VBAC rates fell in both rural and urban hospitals. Nonindicated labor induction rates rose disproportionately faster in rural versus urban settings. Tailored clinical and policy tools are required to address differences between rural and urban hospitals.
在美国每年 400 万例出生中，约有 15%发生在农村医院。
（1）测量农村和城市医院之间产科护理的差异，并（2）检验随时间推移的趋势是否因农村-城市医院位置而异。
这是对 2002-2010 年全国住院患者样本中所有分娩的医院出院记录进行的回顾性分析，该样本构成了美国 20%的医院（N=7188972 例分娩：6316743 例在城市医院，837772 例在农村医院）。
估计低危剖宫产（足月、单胎、头位妊娠；无既往剖宫产史）、剖宫产后阴道分娩（VBAC）、无指征剖宫产和无指征引产的比例。
2010 年，农村和城市医院的低危剖宫产率分别为 15.5%和 16.1%，无指征剖宫产率分别为 16.9%和 17.8%。2010 年，农村和城市医院的 VBAC 率分别为 5.0%和 10.0%。2002 年至 2010 年间，农村和城市医院的低危剖宫产率和无指征剖宫产率均有所上升，VBAC 率均有所下降。2002 年，农村医院的无指征引产率低于城市医院[校正比值比=0.79（0.78-0.81）]，但从 2002 年至 2010 年，农村医院的无指征引产率增长更快[校正比值比=1.05（1.05-1.06）]。2010 年，农村地区 16.5%的分娩是无指征引产（城市地区为 12.0%）。
从 2002 年到 2010 年，农村和城市医院的剖宫产率上升，VBAC 率下降。农村地区的无指征引产率增长速度快于城市地区。需要制定有针对性的临床和政策工具，以解决农村和城市医院之间的差异。
