Differences in Perinatal Outcomes among Rural Women by County Composition

Objective We compared differences in perinatal outcomes among rural and nonrural women, stratified by maternal race/ethnicity. We also examined differences between majority minority rural counties with majority White rural counties. Study Design We conducted a retrospective cohort study with 2015 national vital statistics birth certificate data. Maternal county of residence was identified, and counties with <50,000 people were designated as rural. We compared adverse perinatal outcomes between rural and nonrural residents, stratified by race/ethnicity. Adverse perinatal outcomes included primary term cesarean, preterm birth (PTB) <37 and <32 weeks, neonatal intensive care unit (NICU) admissions, infant death, small for gestational age, and Apgar's scores Results Within the entire cohort, rural residents were more likely to be younger (age >= 35 years, 10.1 vs. 16.8%; p <0.001), Medicaid beneficiaries (50.3 vs. 44.1%; p <0.001), and uninsured (6.6 vs. 4.2%; p <0.001), and less likely to be married (57.4 vs. 60.20%; p <0.001). Rural residence was associated with Apgar's score <7 (adjusted odds ratio [aOR]=2.04; 95% confidence interval [CI]: 1.64-2.54) and <3 (aOR=1.90; 95% CI: 1.04-3.48) among Asian women. Rural residence was also associated with PTB <37 weeks among Black (aOR=1.09; 95% CI: 1.06-1.13) and Asian women (aOR=1.16; 95% CI: 1.03-1.31). When compared with majority White rural county of residence, majority-minority rural county of residence was associated with the adverse perinatal outcomes studied. Conclusion We observed increased rates of adverse perinatal outcomes among rural women. These trends persisted in majority-minority rural. Additional study is needed to find actionable targets for improving outcomes for rural women.