Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States of America.
Department of Undergraduate Medical Education, Geisel School of Medicine, Hanover, New Hampshire, United States of America.
PLoS One. 2024 Oct 3;19(10):e0306859. doi: 10.1371/journal.pone.0306859. eCollection 2024.
Hospital-based labor and delivery units are closing at increasing rates in the rural US, significantly impacting maternal and newborn health. The objective of this study to determine if rurality-measured as distance from the hospital-and socioeconomic status-measured as insurance payor-impact both spontaneous and medically indicated preterm birth incidence at a single rural academic institution.
This was a retrospective cohort study using electronic medical records of patients with singleton pregnancies delivering at a single rural academic institution between 2016-2018. The primary outcome was preterm delivery (PTD) and secondary outcomes included low birth weight (LBW) and intensive care nursery (ICN) admission. The primary exposures included (1) travel time from a patient's address to the hospital and (2) insurance carrier as a proxy for socioeconomic status. Bivariate analyses indicated that travel time, insurance status, race, ethnicity, marital status, number of prenatal visits, gravida and para, and smoking status were significant predictors of all outcomes (LBW, ICN admission, and PTD). Therefore, these predictors were included in the multivariable logistic models.
Within the multivariable logistic model, patients traveling 1-1.5 hours had approximately twice the odds of PTD (Odds Ratio, OR: 2.08, 95% Confidence Interval CI, 1.32, 3.29, p = .002), birth of a LBW neonate (OR: 2.15; 95% CI: 1.29-3.58, p = .005), and infant admission to the ICN (OR 1.83, 95% CI: 1.22-2.76, p = .004) compared to patients traveling under 30 minutes,. Insurance carrier status was not associated with increased odds of PTD, LBW, or ICN admission.
Patients living 1-to-1.5 hours from the hospital had an increased risk for LBW, ICN admission, and PTD, despite living in zip codes with less social deprivation than zip codes further away from the hospital.
美国农村地区的医院分娩单位正在以越来越高的速度关闭，这对母婴健康产生了重大影响。本研究旨在确定距离医院的远近（以农村地区衡量）和保险支付方的社会经济地位（以保险支付方衡量）是否会对单一农村学术机构的自发性和医学指征性早产发生率产生影响。
这是一项回顾性队列研究，使用了 2016 年至 2018 年期间在一家农村学术机构分娩的单胎妊娠患者的电子病历。主要结局是早产（PTD），次要结局包括低出生体重（LBW）和重症监护室（ICN）入院。主要暴露因素包括（1）患者住址到医院的出行时间，（2）作为社会经济地位代理的保险支付方。双变量分析表明，出行时间、保险状况、种族、民族、婚姻状况、产前检查次数、孕次和产次以及吸烟状况是所有结局（LBW、ICN 入院和 PTD）的显著预测因素。因此，这些预测因素被纳入多变量逻辑模型。
在多变量逻辑模型中，出行 1-1.5 小时的患者发生 PTD 的几率大约是出行 30 分钟以内的患者的两倍（优势比，OR：2.08，95%置信区间，CI：1.32，3.29，p =.002），出生低体重儿的几率（OR：2.15；95% CI：1.29-3.58，p =.005）和婴儿入住 ICN 的几率（OR 1.83，95% CI：1.22-2.76，p =.004）高于出行 30 分钟以内的患者。保险支付方的状况与 PTD、LBW 或 ICN 入院的几率增加无关。
尽管居住在离医院较近的邮政编码地区的社会剥夺程度低于离医院较远的邮政编码地区，但距离医院 1 到 1.5 小时的患者发生 LBW、ICN 入院和 PTD 的风险增加。
