Abstract
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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