Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop S107-2, Chamblee, GA, 30341, USA.
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, 321 S Columbia St, Chapel Hill, NC, 27599, USA.
J Community Health. 2022 Oct;47(5):828-834. doi: 10.1007/s10900-022-01116-1. Epub 2022 Jun 30.
The number of U.S. births has been declining. There is also concern about rural obstetric units closing. To better understand the relationship between births and obstetric beds during 2000-2019, we examined changes over time in births, birth hospital distributions (i.e., hospital birth volume, ownership, and urban-rural designation), and the ratio of births to obstetric beds. We analyzed American Hospital Association Annual Survey data from 2000 to 2019. We included U.S. hospitals with at least 25 reported births during the year and at least 1 reported obstetric bed. We categorized birth volume to identify and describe hospitals with maternity services using seven categories. We calculated ratios of number of births to number of obstetric beds overall, by annual birth volume category, by three categories of hospital ownership, and by six urban-rural categories. The ratio of births to obstetric beds, which may represent need for maternity services, has stayed relatively consistent at 65 over the past two decades, despite the decline in births and changes in birth hospital distributions. The ratios were smallest in hospitals with < 250 annual births and largest in hospitals with ≥ 7000 annual births. The largest ratios of births to obstetric beds were in large metro areas and the smallest ratios were in noncore areas. At a societal level, the reduction in obstetric beds corresponds with the drop in the U.S. birth rate. However, consistency in the overall ratio can mask important differences that we could not discern, such as the impact of closures on distances to closest maternity care.
美国的出生率一直在下降。人们还担心农村产科单位关闭。为了更好地了解 2000 年至 2019 年期间出生率和产科床位之间的关系，我们研究了出生率、分娩医院分布（即医院分娩量、所有权和城乡指定）以及出生率与产科床位比例随时间的变化。我们分析了 2000 年至 2019 年美国医院协会年度调查数据。我们纳入了每年至少报告 25 例分娩和至少报告 1 张产科床位的美国医院。我们对分娩量进行了分类，以使用七个类别来确定和描述有产科服务的医院。我们计算了总的出生人数与产科床位人数的比例、按年度出生量分类的比例、按三种医院所有权分类的比例和按六个城乡分类的比例。过去二十年，尽管出生率下降和分娩医院分布发生变化，但代表对产科服务需求的出生人数与产科床位人数的比例相对稳定，保持在 65 左右。在每年分娩量<250 的医院中，比例最小，在每年分娩量≥7000 的医院中，比例最大。在大型地铁地区，出生人数与产科床位人数的比例最大，而非核心地区的比例最小。从社会层面来看，产科床位的减少与美国出生率的下降相对应。然而，总体比例的一致性掩盖了我们无法察觉的重要差异，例如关闭对最近产妇护理距离的影响。
