ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2024
Effects of rurality and distance to care on perinatal outcomes over a 1-year period during the COVID-19 pandemic.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it, 7 citations in OpenAlex.
- Towards the Development of a Conceptual Framework of the Determinants of Pre-Eclampsia: A Hierarchical Systematic Review of Social Determinants.BJOG : an international journal of obstetrics and gynaecology · 2026Pooled it
- Maternal Weathering and Infant Health: Understanding Low Birth Weight and Preterm Birth Among American Indians.Journal of racial and ethnic health disparities · 2026Article
- Article
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
Abstract
purposeOur aim was to investigate the roles of rurality and distance to care on adverse perinatal outcomes and COVID-19 seroprevalence at the time of delivery over a 1-year period.
methodsData were collected from the electronic medical record on all pregnant patients who delivered at a single, large, Midwest academic medical center over 1 year. Rurality was classified using standard Rural-Urban Commuting Area codes. Geographic Information System tools were used to map outcomes. Data were analyzed with univariate and multivariate models, controlling for Body Mass Index (BMI), insurance status, and parity.
findingsA total of 2,497 patients delivered during the study period; 20% of patients were rural (n = 499), 18.6% were micropolitan (n = 466), and 61.4% were metropolitan (n = 1,532). 10.4% of patients (n = 259) were COVID-19 seropositive. Rural patients did not experience higher rates of any measured adverse outcomes than metropolitan patients; micropolitan patients had increased odds of preterm labor (OR = 1.41, P = .022) and pre-eclampsia (OR = 1.78, P<.001). Patients living 30+ miles away from the medical center had increased odds of preterm labor (OR = 1.94, P<.001), pre-eclampsia (OR = 1.73, P = .002), and infant admission to the neonatal intensive care unit (OR = 2.12, P<.001), as well as lower gestational age at delivery (β = -9.2 days, P<.001) and birth weight (β = -206 grams, P<.001).
conclusionDistance to care, rather than rurality, was the key predictor of multiple adverse perinatal outcomes in this cohort of deliveries over a 1-year period. Our study suggests that rurality should not be used as a standalone indicator of access to care without further knowledge of the specific barriers affecting a given population.
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