Department of Health Services and Policy Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, South Carolina, USA.
J Rural Health. 2022 Jan;38(1):171-179. doi: 10.1111/jrh.12554. Epub 2021 Feb 22.
Distances to obstetric care providers are a persistent concern, especially for rural pregnant adolescents. Births to adolescents are disproportionately affected by adverse birth outcomes (ABOs), yet little is known regarding how driving distances may impact ABOs. This study examines the association between driving distances to obstetric providers and ABOs among adolescent mothers in South Carolina.
This retrospective cross-sectional study derived ZIP Code-level birth statistics from mothers aged 10-19 in South Carolina using 2013-2017 statewide birth certificate data. ABOs included preterm birth and/or low birthweight. Provider distance was calculated between an obstetric provider's ZIP Code tabulated area (ZCTA) centroid and a maternal resident's ZCTA centroid. Descriptive statistics and weighted generalized linear regression were conducted.
Mean provider distances to obstetric providers were similar between urban (11.76 miles) and rural adolescent mothers (12.04 miles). An increase in provider distance, on average, was associated with a decrease in ABO rates (-0.79, p= .0038); however, rural-urban differences were found. Living in a rural ZCTA was associated with a decrease in ABOs (4.94%, p = .0043). Urban ZCTAs showed a U-shaped association with provider distance, with ABO rates decreasing until approximately 17 miles away from a provider and then increasing.
Rural adolescent mothers with greater distance to providers had lower ABO rates, while, in urban ZCTAs, provider distance over 17 miles was associated with higher ABO rates. Understanding what mitigates the effects of driving distance on ABOs in rural South Carolina would help inform future policy planning in underserved communities.
医疗服务提供者的距离一直是一个令人关注的问题，尤其是对于农村地区的孕妇青少年而言。青少年的分娩受到不良分娩结局（ABO）的不成比例影响，但对于驾驶距离如何影响 ABO 的问题知之甚少。本研究考察了南卡罗来纳州青少年母亲的产科提供者距离与 ABO 之间的关联。
本回顾性横断面研究从南卡罗来纳州使用 2013-2017 年全州出生证明数据的 10-19 岁母亲中获得邮政编码级别的出生统计数据。ABO 包括早产和/或低出生体重。产科提供者的距离是根据产科提供者的邮政编码表区（ZCTA）质心和产妇居民的 ZCTA 质心计算得出的。进行了描述性统计和加权广义线性回归。
城市（11.76 英里）和农村青少年母亲（12.04 英里）之间平均提供者距离相似。提供者距离平均增加与 ABO 率降低相关（-0.79，p=.0038）；但是，城乡差异明显。居住在农村 ZCTA 与 ABO 减少相关（4.94%，p =.0043）。城市 ZCTA 与提供者距离呈 U 形关联，在距离提供者约 17 英里之前，ABO 率下降，然后增加。
距离提供者较远的农村青少年母亲 ABO 率较低，而在城市 ZCTA 中，距离提供者超过 17 英里与 ABO 率较高相关。了解是什么减轻了农村南卡罗来纳州驾驶距离对 ABO 的影响，将有助于为服务不足的社区提供未来的政策规划。
