Effects of rurality and distance to care on perinatal outcomes over a 1-year period during the COVID-19 pandemic

Pratyusha V Bujimalla; Kimberly A Kenne; Haley A Steffen; Samantha R Swartz; Linder H Wendt; Adam M Skibbe; J Brooks Jackson; Mary B Rysavy

doi:10.1111/jrh.12820

Effects of rurality and distance to care on perinatal outcomes over a 1-year period during the COVID-19 pandemic

J Rural Health. 2023 Dec 27. doi: 10.1111/jrh.12820. Online ahead of print.

Authors

Pratyusha V Bujimalla¹, Kimberly A Kenne², Haley A Steffen¹, Samantha R Swartz², Linder H Wendt³, Adam M Skibbe⁴, J Brooks Jackson⁵, Mary B Rysavy^{2

6}

Affiliations

¹ University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
² Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA.
³ Institute of Clinical and Translational Science, University of Iowa, Iowa City, Iowa, USA.
⁴ Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, Iowa, USA.
⁵ Department of Pathology, University of Iowa, Iowa City, Iowa, USA.
⁶ Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA.

PMID: 38151483
DOI: 10.1111/jrh.12820

Abstract

Purpose: Our aim was to investigate the roles of rurality and distance to care on adverse perinatal outcomes and COVID-19 seroprevalence at the time of delivery over a 1-year period.

Methods: Data were collected from the electronic medical record on all pregnant patients who delivered at a single, large, Midwest academic medical center over 1 year. Rurality was classified using standard Rural-Urban Commuting Area codes. Geographic Information System tools were used to map outcomes. Data were analyzed with univariate and multivariate models, controlling for Body Mass Index (BMI), insurance status, and parity.

Findings: A total of 2,497 patients delivered during the study period; 20% of patients were rural (n = 499), 18.6% were micropolitan (n = 466), and 61.4% were metropolitan (n = 1,532). 10.4% of patients (n = 259) were COVID-19 seropositive. Rural patients did not experience higher rates of any measured adverse outcomes than metropolitan patients; micropolitan patients had increased odds of preterm labor (OR = 1.41, P = .022) and pre-eclampsia (OR = 1.78, P<.001). Patients living 30+ miles away from the medical center had increased odds of preterm labor (OR = 1.94, P<.001), pre-eclampsia (OR = 1.73, P = .002), and infant admission to the neonatal intensive care unit (OR = 2.12, P<.001), as well as lower gestational age at delivery (β = -9.2 days, P<.001) and birth weight (β = -206 grams, P<.001).

Conclusion: Distance to care, rather than rurality, was the key predictor of multiple adverse perinatal outcomes in this cohort of deliveries over a 1-year period. Our study suggests that rurality should not be used as a standalone indicator of access to care without further knowledge of the specific barriers affecting a given population.

Keywords: COVID-19; adverse perinatal outcomes; rurality.

Abstract

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