ERIC Number: EJ928923
Record Type: Journal
Publication Date: 2011
Abstractor: As Provided
Reference Count: 53
Birth Outcomes among Older Mothers in Rural versus Urban Areas: A Residence-Based Approach
Lisonkova, Sarka; Sheps, Samuel B.; Janssen, Patricia A.; Lee, Shoo K.; Dahlgren, Leanne; MacNab, Ying C.
Journal of Rural Health, v27 n2 p211-219 Spr 2011
Purpose: 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. Methods: 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 (less than 50, 50-150, greater than 150 km). Outcomes included labor induction, cesarean section, stillbirth, perinatal death, preterm birth (less than 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). Findings: Among the 29,698 subjects, 11.5% lived in rural areas; 5% lived within 50-150 km; and 1.1% lived greater than 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. Conclusions: 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.
Descriptors: Prenatal Care, Intervals, Mothers, Hospitals, Premature Infants, Urban Areas, Rural Areas, Foreign Countries, Correlation, Age, Birth, Death, Multivariate Analysis, Risk, Obstetrics, Females, Decision Making, Referral
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Publication Type: Journal Articles; Reports - Research
Education Level: N/A
Authoring Institution: N/A
Identifiers - Location: Canada