The Influence of Proximity of Perinatal Services on Preterm Birth Rates in Non-Metropolitan Georgia, 1999-2009 Open Access

Anderson, Alexandra Quinn (2013)

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Preterm birth (<37 weeks) is a leading cause of perinatal morbidity and mortality and between 2000 and 2009, the rate of infants born preterm in Georgia rose from 11.6% to 13.8%. Access to perinatal services and providers, especially to women at risk of preterm delivery, is associated with a decreased risk of preterm birth. We used Georgia's birth records linked to hospital discharge records (1999 through 2009) to model the association between women's travel time from residence in rural or micropolitan regions of Georgia to hospitals and rates of preterm birth among live, singleton births born between 24 and 37 weeks gestation. Using multivariable modeling to control for confounders, we found that proximity of residence to delivery facility is associated with preterm birth. Independent of common individual and population level risk factors, women living outside of metropolitan areas in Georgia, with more than 45 minutes road-network travel time between home and delivery hospital, are more than 1.5 times as likely to experience preterm delivery compared to women with less than 45 minutes road-network travel time to delivery hospital. Addressing the geographic disparities in preterm birth may require reduction in the spatial mismatch of perinatal services and population at risk in rural Georgia.

Table of Contents

Introduction__________________________________ 1 Literature Review______________________________ 2 Methods_____________________________________16 Results______________________________________19 Discussion____________________________________23 Implications___________________________________26 References___________________________________28 Figures_______________________________________31 Table 1a. Descriptive statistics of singleton births by drive time_______31 Table 1b. Distribution of singleton births by drive time intervals________32 Table 2. Parameter estimates for preterm birth _____________________33 Table 3. Multiplicative Interaction of Maternal Transfer and Drive Time__34 Appendix 35 A. Map of Non-Metropolitan Areas of Georgia____________________ 35 B. International Review Board Approval_________________________ 36

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