Rural-Urban Differences In Severe Maternal Morbidity And Mortality In The US, 2007–15

TLDR

Severe maternal morbidity and mortality are rising in the United States, disproportionately affecting rural communities that face workforce shortages, low patient volumes, the opioid epidemic, and social determinants such as transportation, poverty, and violence. We analyzed 2007–2015 National Inpatient Sample data on childbirth hospitalizations to compare severe maternal morbidity and mortality between rural and urban residents. The rate of severe maternal morbidity and mortality rose from 109 to 152 per 10,000 childbirth hospitalizations between 2007 and 2015, and rural residents had a 9 % higher adjusted probability of such events compared with urban residents.

Abstract

In the United States, severe maternal morbidity and mortality is climbing—a reality that is especially challenging for rural communities, which face declining access to obstetric services. Severe maternal morbidity refers to potentially life-threatening complications or the need to undergo a lifesaving procedure during or immediately following childbirth. Using data for 2007–15 from the National Inpatient Sample, we analyzed severe maternal morbidity and mortality during childbirth hospitalizations among rural and urban residents. We found that severe maternal morbidity and mortality increased among both rural and urban residents in the study period, from 109 per 10,000 childbirth hospitalizations in 2007 to 152 per 10,000 in 2015. When we controlled for sociodemographic factors and clinical conditions, we found that rural residents had a 9 percent greater probability of severe maternal morbidity and mortality, compared with urban residents. Attention to the challenges faced by rural patients and health care facilities is crucial to the success of efforts to reduce maternal morbidity and mortality in rural areas. These challenges include both clinical factors (workforce shortages, low patient volume, and the opioid epidemic) and social determinants of health (transportation, housing, poverty, food security, racism, violence, and trauma).