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 <7 and <3 at 5minutes. Majority-minority rural counties were defined as counties having <50% White women. We compared perinatal outcomes among this cohort to those of women from majority White rural counties. Bivariate analysis and multivariable logistic regression were performed. 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. Key Points Rural county of residence was associated with lower socioeconomic markers. Perinatal outcomes were worse among women from rural counties. Differences in perinatal outcomes exist among rural women by race/ethnicity.