Handley Sara C, Interrante Julia D, Gregory Emily F, Kozhimannil Katy B
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Rural Health. 2025 Jun;41(3):e70062. doi: 10.1111/jrh.70062.
To examine differences in perinatal health between rural and urban postpartum parents and infants and within postpartum parent-infant dyads.
Cross-sectional analysis of the National Health Interview Survey (NHIS) data. Accounting for the complex survey design, we calculated weighted proportions of measures of self-rated health, health care utilization, and barriers to care and used chi-squared tests to assess rural-urban differences between postpartum parents and between infants, and repeated measures to test postpartum parent-infant differences within households in rural and urban counties.
The study included 2019 rural postpartum parents, 2191 rural infants, 12,112 urban postpartum parents and 13,088 urban infants. Compared to urban postpartum parents, those living in rural areas were less likely to see an obstetrician-gynecologist (p = 0.002) had more emergency department (ED) visits (p = 0.030), reported more hospitalizations (p = 0.041), more frequently experienced uninsurance (p = 0.006), and lost Medicaid coverage after pregnancy (p = 0.006). While a higher proportion of urban infants were hospitalized than their rural counterparts (p = 0.019), other measures were similar. Accounting for dyad correlations, compared to infants, postpartum parents generally reported worse health (fair or poor self-rated health), and were more likely to experience ED visits, hospitalizations, loss of health care coverage, and barriers to care.
Rural postpartum parents experience worse health than their urban counterparts and compared to their infants. Rural-urban differences in access were less common among infants, thus leveraging infant care systems for services to both the infant and postpartum parent may improve household health in all communities.
研究农村和城市产后父母及婴儿之间以及产后母婴二元组内部围产期健康状况的差异。
对国家健康访谈调查（NHIS）数据进行横断面分析。考虑到复杂的调查设计，我们计算了自我评估健康、医疗保健利用及护理障碍指标的加权比例，并使用卡方检验评估产后父母之间以及婴儿之间的城乡差异，同时采用重复测量法检验农村和城市县家庭内部产后母婴差异。
该研究纳入了2019名农村产后父母、2191名农村婴儿、12112名城市产后父母和13088名城市婴儿。与城市产后父母相比，农村地区的产后父母看妇产科医生的可能性较小（p = 0.002），急诊就诊次数更多（p = 0.030），住院次数更多（p = 0.041），未参保情况更频繁（p = 0.006），且产后失去医疗补助覆盖（p = 0.006）。虽然城市婴儿住院的比例高于农村婴儿（p = 0.019），但其他指标相似。考虑到二元组相关性，与婴儿相比，产后父母通常报告健康状况较差（自我评估健康为一般或较差），并且更有可能经历急诊就诊、住院、失去医疗保健覆盖以及护理障碍。
农村产后父母的健康状况比城市产后父母差，也比他们自己的婴儿差。婴儿在获得医疗服务方面的城乡差异较少，因此利用婴儿护理系统为婴儿和产后父母提供服务可能会改善所有社区家庭的健康状况。
