Division of Maternal Fetal Medicine and Reproductive Genetics, University Of North Carolina At Chapel Hill, Chapel Hill, NC, 27599.
Division of Maternal Fetal Medicine, University of California San Francisco, San Francisco, CA.
Genet Med. 2024 Nov;26(11):101221. doi: 10.1016/j.gim.2024.101221. Epub 2024 Jul 20.
To describe the association between geographic location of residence and use of aneuploidy screening or prenatal genetic counseling and how it is modified by maternal race and ethnicity.
Retrospective cohort of individuals at a tertiary care center between 2017-2019. County of residence was classified as rural or metropolitan based in US Office of Management and Budget 2019 definitions. Maternal race and ethnicity were self-identified. Our composite outcome was defined as use of aneuploidy screening or genetic counseling visit. The composite outcome was compared by geographic location and ethnicity. Logistic regression was used to model the relationship between geographic location and the composite outcome.
A total of 8774 pregnancies were included. Of these, 4770 (54%) had genetic screening, and 3781 (43%) had at least 1 genetic counseling visit. Rural patients were significantly less likely to have the composite outcome compared with metropolitan peers (37.1% vs 47.2%, P < .001). In addition, we identified differences in the composite outcome between White rural patients and LatinX rural patients (37.7% vs 35.6%, P < .001) and between Asian rural patients and LatinX and Black rural patients (41.0% vs 35.6%, P < .001; 41.0% vs 36.8%, P < .001). Logistic regression demonstrated that rural patients were significantly less likely to have the composite outcome compared with metropolitan peers, after adjusting for LatinX ethnicity and gestational age at first prenatal visit (OR 0.72, [0.55, 0.95], P = .002).
Rural, minority patients were significantly less likely to receive reproductive genetic services compared with metropolitan peers extending our knowledge of disparities in maternity care.
描述居住地理位置与非整倍体筛查或产前遗传咨询的使用之间的关系，并探讨其如何受产妇种族和民族的影响。
本研究为回顾性队列研究，纳入了 2017 年至 2019 年期间在一家三级保健中心就诊的个体。根据美国管理和预算办公室 2019 年的定义，将居住地所在县分为农村或大都市。产妇种族和民族为自我认定。我们的复合结局定义为使用非整倍体筛查或遗传咨询就诊。通过地理位置和民族比较复合结局。使用逻辑回归模型来分析地理位置与复合结局之间的关系。
共纳入 8774 例妊娠。其中，4770 例（54%）接受了遗传筛查，3781 例（43%）至少接受了 1 次遗传咨询。与大都市患者相比，农村患者发生复合结局的可能性显著降低（37.1%比 47.2%，P<0.001）。此外，我们还发现白种人农村患者与拉丁裔农村患者（37.7%比 35.6%，P<0.001）以及亚洲农村患者与拉丁裔和黑种人农村患者（41.0%比 35.6%，P<0.001；41.0%比 36.8%，P<0.001）之间存在复合结局的差异。逻辑回归表明，在校正了拉丁裔民族和首次产前就诊时的孕龄后，农村患者发生复合结局的可能性显著低于大都市患者（比值比 0.72，[0.55，0.95]，P=0.002）。
与大都市患者相比，农村少数民族患者接受生殖遗传服务的可能性显著降低，这进一步加深了我们对孕产妇保健差异的认识。
