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- Title
Birth Outcomes Among Older Mothers in Rural Versus Urban Areas: A Residence-Based Approach.
- Authors
Lisonkova, Sarka; Sheps, Samuel B.; Janssen, Patricia A.; Lee, Shoo K.; Dahlgren, Leanne; MacNab, Ying C.
- Abstract
We examined the association between rural residence and birth outcomes in older mothers, the effect of parity on this association, and the trend in adverse birth outcomes in relation to the distance to the nearest hospital with cesarean-section capacity. A population-based retrospective cohort study, including all singleton births to 35+ year-old women in British Columbia (Canada), 1999-2003. We compared birth outcomes in rural versus urban areas, and between 3 distance categories to a hospital (<50, 50-150, >150 km). Outcomes included labor induction, cesarean section, stillbirth, perinatal death, preterm birth (<37 weeks), small-for-gestational-age, large-for-gestational-age, and neonatal intensive care unit admission. We used multivariate regression to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Among the 29,698 subjects, 11.5% lived in rural areas; 5% lived within 50-150 km; and 1.1% lived >150 km from a hospital. Rural women were at lower risk of primary and repeat cesarean section (OR = 0.9, CI: 0.9-1.0; OR = 0.7, CI: 0.6-0.9) and small-for-gestational-age (OR = 0.8, CI: 0.7-0.9) births; they were at increased risk for perinatal death (OR = 1.5, CI: 1.1-2.1) and large-for-gestational-age (OR = 1.1, CI: 1.1-1.2) births. The association was stronger among multiparous versus primiparous women. No differences in emergency cesarean section, preterm birth, or neonatal intensive care admission were found, regardless of parity. Perinatal mortality increased with distance from hospital; OR = 1.5 (CI: 1.1-2.1) per distance category. Older women in rural versus urban areas had a lower rate of cesarean section and increased risk of perinatal death. The risk of perinatal death increased with the distance to hospital. Further studies need to evaluate the contribution of underlying perinatal risks, access to care, and decision making regarding referral and transport.
- Subjects
BRITISH Columbia; CESAREAN section; CHI-squared test; COMPARATIVE studies; COMPUTER software; CONFIDENCE intervals; EPIDEMIOLOGY; HEALTH services accessibility; LONGITUDINAL method; MATERNAL age; MATERNAL health services; EVALUATION of medical care; METROPOLITAN areas; PSYCHOLOGY of mothers; MULTIVARIATE analysis; PREGNANCY; REGRESSION analysis; RURAL conditions; LOGISTIC regression analysis; DATA analysis; RELATIVE medical risk; RETROSPECTIVE studies
- Publication
Journal of Rural Health, 2011, Vol 27, Issue 2, p211
- ISSN
0890-765X
- Publication type
Article
- DOI
10.1111/j.1748-0361.2010.00332.x