Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, and the Magee-Womens Research Institute, Pittsburgh, Pennsylvania.
Obstet Gynecol. 2022 Nov 1;140(5):812-819. doi: 10.1097/AOG.0000000000004960. Epub 2022 Oct 5.
To assess whether there are associations between driving distance from the patient residence to the delivery hospital and adverse maternal and perinatal health outcomes.
We performed a retrospective cohort study using 2011-2015 Pennsylvania birth records of live births at 20 weeks of gestation or more, excluding inpatient hospital transfers or implausible distances. The shortest driving distance from patient residence to the delivery hospital was calculated in ArcGIS and was evaluated in association with a composite of adverse maternal outcomes (blood transfusion, unplanned operation, ruptured uterus, unplanned hysterectomy, or intensive care unit admission) and neonatal intensive care unit (NICU) admission. Multivariable-adjusted Poisson models were used to estimate relative risks with 95% CIs with a referent difference of 1 km distance to the delivery hospital.
A total 662,245 birth records were included, and the median driving distance to the hospital was 11.3 km (interquartile range 5.4-21.6 km). The overall rate of the composite maternal outcome was 0.6% and of NICU admission was 8.4%. Compared with the referent distance, increasing driving distance was significantly associated with increased adjusted risks of the maternal composite outcome (adjusted relative risk [aRR] 1.22, 95% CI 1.07-1.36 for 60 km; aRR 1.36, 95% CI 1.19-1.53 for 70 km; and 1.53, 95% CI 1.31-1.75 for 80 km) and NICU admission (aRR 1.70, 95% CI 1.65-1.76 for 60 km; aRR 1.96, 95% CI 1.90-2.02 for 70 km; and aRR 2.25, 95% CI 2.18-2.33 for 80 km).
Longer distances to the delivery hospital were associated with greater risk of adverse maternal outcomes and NICU admission. Whether these findings reflect health care delivery deficits or simply serve as a marker of social deprivation requires further study.
评估产妇居住地到分娩医院的距离与产妇和围产儿不良健康结局之间是否存在关联。
我们使用宾夕法尼亚州 2011-2015 年 20 周以上活产分娩的出生记录进行了回顾性队列研究，排除了住院医院的转移或不合理的距离。在 ArcGIS 中计算了从患者居住地到分娩医院的最短行车距离，并将其与不良产妇结局（输血、非计划手术、子宫破裂、非计划子宫切除术或重症监护病房入院）和新生儿重症监护病房（NICU）入院的综合指标进行了评估。使用多变量调整泊松模型，以分娩医院距离相差 1 公里的参考差异来估计相对风险比及其 95%置信区间。
共纳入 662245 份分娩记录，到医院的中位行车距离为 11.3 公里（四分位距 5.4-21.6 公里）。总体复合产妇结局发生率为 0.6%，NICU 入院率为 8.4%。与参考距离相比，随着行车距离的增加，产妇复合结局的调整风险显著增加（调整后的相对风险 [aRR] 60 公里时为 1.22（95%CI 1.07-1.36）；70 公里时为 1.36（95%CI 1.19-1.53）；80 公里时为 1.53（95%CI 1.31-1.75））和 NICU 入院率（aRR 60 公里时为 1.70（95%CI 1.65-1.76）；70 公里时为 1.96（95%CI 1.90-2.02）；80 公里时为 2.25（95%CI 2.18-2.33））。
到分娩医院的距离越远，产妇不良结局和 NICU 入院的风险越高。这些发现是否反映了医疗保健服务的不足，或者仅仅是社会贫困的标志，还需要进一步研究。
