Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon.
Am J Perinatol. 2024 May;41(S 01):e249-e258. doi: 10.1055/a-1878-0204. Epub 2022 Jun 16.
We compared differences in perinatal outcomes among rural and nonrural women, stratified by maternal race/ethnicity. We also examined differences between majority minority rural counties with majority White rural counties.
We conducted a retrospective cohort study with 2015 national vital statistics birth certificate data. Maternal county of residence was identified, and counties with <50,000 people were designated as rural. We compared adverse perinatal outcomes between rural and nonrural residents, stratified by race/ethnicity. Adverse perinatal outcomes included primary term cesarean, preterm birth (PTB) <37 and <32 weeks, neonatal intensive care unit (NICU) admissions, infant death, small for gestational age, and Apgar's scores <7 and <3 at 5minutes. Majority-minority rural counties were defined as counties having <50% White women. We compared perinatal outcomes among this cohort to those of women from majority White rural counties. Bivariate analysis and multivariable logistic regression were performed.
Within the entire cohort, rural residents were more likely to be younger (age ≥35 years, 10.1 vs. 16.8%; <0.001), Medicaid beneficiaries (50.3 vs. 44.1%; <0.001), and uninsured (6.6 vs. 4.2%; <0.001), and less likely to be married (57.4 vs. 60.20%; <0.001). Rural residence was associated with Apgar's score <7 (adjusted odds ratio [aOR]=2.04; 95% confidence interval [CI]: 1.64-2.54) and <3 (aOR=1.90; 95% CI: 1.04-3.48) among Asian women. Rural residence was also associated with PTB <37 weeks among Black (aOR=1.09; 95% CI: 1.06-1.13) and Asian women (aOR=1.16; 95% CI: 1.03-1.31). When compared with majority White rural county of residence, majority-minority rural county of residence was associated with the adverse perinatal outcomes studied.
We observed increased rates of adverse perinatal outcomes among rural women. These trends persisted in majority-minority rural. Additional study is needed to find actionable targets for improving outcomes for rural women.
· Rural county of residence was associated with lower socioeconomic markers.. · Perinatal outcomes were worse among women from rural counties.. · Differences in perinatal outcomes exist among rural women by race/ethnicity..
我们比较了农村和非农村妇女在围产期结局方面的差异，并按产妇种族/民族进行分层。我们还研究了少数民族为主的农村县与白人为主的农村县之间的差异。
我们进行了一项回顾性队列研究，使用了 2015 年全国人口统计出生证明数据。确定了产妇的居住县，将人口少于 5 万人的县指定为农村县。我们比较了农村和非农村居民之间的不良围产期结局，按种族/民族进行分层。不良围产期结局包括原发性足月剖宫产、早产（<37 周和<32 周）、新生儿重症监护病房（NICU）入院、婴儿死亡、小于胎龄儿和出生后 5 分钟 Apgar 评分<7 和<3。少数民族为主的农村县定义为白人女性比例<50%的县。我们将该队列的围产期结局与白人为主的农村县的围产期结局进行了比较。进行了双变量分析和多变量逻辑回归。
在整个队列中，农村居民更年轻（年龄≥35 岁，10.1%比 16.8%；<0.001），更多的是医疗补助受益人（50.3%比 44.1%；<0.001），更多的是无保险者（6.6%比 4.2%；<0.001），更少的是已婚者（57.4%比 60.20%；<0.001）。农村居民的 Apgar 评分<7（调整后的优势比[aOR]=2.04；95%置信区间[CI]：1.64-2.54）和<3（aOR=1.90；95% CI：1.04-3.48）与亚洲妇女有关。农村居民的早产（<37 周）与黑人（aOR=1.09；95% CI：1.06-1.13）和亚洲妇女（aOR=1.16；95% CI：1.03-1.31）也有关。与白人为主的农村县相比，少数民族为主的农村县与研究中的不良围产期结局有关。
我们观察到农村妇女不良围产期结局的发生率增加。这些趋势在少数民族为主的农村地区仍然存在。需要进一步研究以确定改善农村妇女结局的可操作目标。
·农村县的居住与较低的社会经济指标有关。·农村县的产妇围产期结局更差。·农村妇女的围产期结局按种族/民族存在差异。
