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

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

Journal article

Open access

Peer reviewed

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 and Mary B Rysavy

The Journal of rural health, Vol.40(3), pp.520-530

Summer 2024

DOI: 10.1111/jrh.12820

PMCID: PMC11186728

PMID: 38151483

Appears in UI Libraries Support Open Access

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Abstract

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. 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. 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). 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.

COVID-19

adverse perinatal outcomes

rurality

UIOWA OA Agreement

Details

Title: Subtitle: Effects of rurality and distance to care on perinatal outcomes over a 1-year period during the COVID-19 pandemic
Creators: Pratyusha V Bujimalla - University of Iowa
Kimberly A Kenne - Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA
Haley A Steffen - University of Iowa
Samantha R Swartz - University of Iowa
Linder H Wendt - University of Iowa
Adam M Skibbe - University of Iowa
J Brooks Jackson - University of Iowa
Mary B Rysavy - The University of Texas Health Science Center at Houston
Resource Type: Journal article
Publication Details: The Journal of rural health, Vol.40(3), pp.520-530
DOI: 10.1111/jrh.12820
PMID: 38151483
PMCID: PMC11186728
NLM abbreviation: J Rural Health
eISSN: 1748-0361
Publisher: Wiley
Grant note: UL1TR002537 / NIH HHS
Language: English
Electronic publication date: 12/27/2023
Date published season: Summer 2024
Date published: 2024
Academic Unit: Pathology; Family and Community Medicine; Obstetrics and Gynecology
Record Identifier: 9984536733602771

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