Department of Obstetrics and Gynecology, the Divisions of Reproductive and Population Health and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, and the School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin.
Obstet Gynecol. 2020 Mar;135(3):685-695. doi: 10.1097/AOG.0000000000003718.
To evaluate the peripartum transfusion rates for rural women compared with urban women in the United States.
In this population-based retrospective cohort study, geocoded birth records from 2014 to 2016 from the National Center for Health Statistics were used to examine the rural-urban differences in blood transfusion among nulliparous women delivering singleton, vertex pregnancies at term. We compared transfusion rates across the counties on a continuum from urban to rural. We generated a multivariable logistic regression model controlling for age, race, nativity, education, insurance, prenatal care, maternal health, gestational age, intrapartum care, mode of delivery, peripartum factors, and county of delivery.
Among 3,346,816 births, the transfusion rates based on maternal county of residence increased as the counties became more rural: large metropolitan-center (1.9/1,000 live births); large metropolitan-fringe (2.4); medium metropolitan (2.6); small metropolitan (2.6); micropolitan (4.5); and noncore rural (5.3). Rural women living and delivering in a rural county had more transfusions (8.5/1,000 live births) than women in more urban counties (2.5/1,000). After adjusting for key covariates, the odds of transfusion were higher among women living in micropolitan (adjusted odds ratio [aOR] 2.25, 95% CI 2.09-2.43) and noncore rural (aOR 2.59, 95% CI 2.38-2.81) counties when compared with women living in large metropolitan counties. County of delivery had a higher association with transfusion than resident county. After adding delivery county to the regression model, the association of transfusion and living in a micropolitan (aOR 1.39, 95% CI 1.19-1.63) or noncore rural (aOR 1.32, 95% CI 1.12-1.55) county diminished.
The odds of blood transfusion were higher for women in rural areas. The results indicate that the rurality of the county where the birth occurred was associated with more transfusion. This may reflect differences in maternity and blood banking services in rural hospitals and warrants further study to identify opportunities for intervention.
评估美国农村妇女与城市妇女在围产期的输血率。
本研究采用基于人群的回顾性队列研究，利用 2014 年至 2016 年美国国家卫生统计中心的地理编码分娩记录，检查了在足月、头位单胎分娩的初产妇中，农村和城市地区之间输血的差异。我们比较了从城市到农村连续不断的县之间的输血率。我们生成了一个多变量逻辑回归模型，控制了年龄、种族、出生地、教育程度、保险、产前护理、产妇健康、胎龄、分娩期间护理、分娩方式、围产期因素和分娩县。
在 3346816 例分娩中，基于产妇居住地的县的输血率随着县的农村程度增加而增加：大都会中心（每 1000 例活产 1.9 例）；大都市边缘（2.4）；中等大都市（2.6）；小城市（2.6）；小城市（4.5）；非核心农村（5.3）。在农村县居住和分娩的农村妇女的输血率（每 1000 例活产 8.5 例）高于居住在更城市化县的妇女（每 1000 例活产 2.5 例）。在调整了关键协变量后，与居住在大城市县的妇女相比，居住在小城市（调整后的优势比[aOR]2.25，95%可信区间[CI]2.09-2.43）和非核心农村（aOR 2.59，95%CI 2.38-2.81）县的妇女接受输血的几率更高。与居住地相比，分娩县与输血的关联更高。在将分娩县纳入回归模型后，居住在小城市（aOR 1.39，95%CI 1.19-1.63）或非核心农村（aOR 1.32，95%CI 1.12-1.55）县与输血的关联减弱。
农村妇女输血的几率更高。结果表明，分娩发生的县的农村程度与更多的输血有关。这可能反映了农村医院的产妇和血库服务的差异，需要进一步研究以确定干预机会。
