Rural-Urban Differences in Obstetric Care, 2002-2010, and Implications for the Future
Rural-Urban Differences in Obstetric Care, 2002-2010, and Implications for the Future
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DOI：
10.1097/mlr.0000000000000016
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发表时间：
2014-01-01
期刊：
影响因子：
3
通讯作者：
Moscovice, Ira
中科院分区：
文献类型：
--
作者：
Kozhimannil, Katy B.;Hung, Peiyin;Moscovice, Ira
背景：美国每年400万新生儿中约有15%发生在农村医院。目的：(1)衡量农村和城市医院产科护理的差异，(2)检查农村和城市医院所在地的趋势是否随时间而不同。研究设计和研究对象：本研究对2002-2010年全国住院患者样本中所有出生的出院记录进行回顾性分析，该样本占美国医院样本的20% （N=7,188,972例出生：6,316,743例在城市医院，837,772例在农村医院）。测量方法：评估低风险剖宫产（足月、单胎、顶点妊娠、无剖宫产史）、剖宫产后阴道分娩（VBAC）、无指征剖宫产和无指征引产的发生率。结果：2010年城乡医院低风险剖宫产率分别为15.5%和16.1%，无指征剖宫产率分别为16.9%和17.8%。2010年农村医院VBAC率为5.0%，城市医院为10.0%。2002年至2010年间，农村和城市医院的低风险剖宫产率和无指征剖宫产率上升，VBAC率下降。2002年农村医院无指征引产发生率低于城市医院[调整优势比=0.79(0.78-0.81)]，但2002 - 2010年农村医院无指征引产发生率上升较快[调整优势比=1.05(1.05-1.06)]。2010年，16.5%的农村分娩是无指征引产（城市分娩为12.0%）。结论：2002 - 2010年，城乡医院剖宫产率上升，VBAC率下降。与城市环境相比，农村地区未指明的引产率上升得更快。需要有针对性的临床和政策工具来解决农村和城市医院之间的差异。
Background:Approximately 15% of the 4 million annual US births occur in rural hospitals.Objective:To (1) measure differences in obstetric care in rural and urban hospitals, and to (2) examine whether trends over time differ by rural-urban hospital location.Research Design and Subjects:This was a retrospective analysis of hospital discharge records for all births in the 2002-2010 Nationwide Inpatient Sample, which constitutes 20% sample of US hospitals (N=7,188,972 births: 6,316,743 in urban hospitals, 837,772 in rural hospitals).Measures:Rates of low-risk cesarean (full-term, singleton, vertex pregnancies; no prior cesarean), vaginal birth after cesarean (VBAC), nonindicated cesarean, and nonindicated labor induction were estimated.Results:In 2010, low-risk cesarean rates in rural and urban hospitals were 15.5% and 16.1%, respectively, and nonindicated cesarean rates were 16.9% and 17.8%, respectively. VBAC rates were 5.0% in rural and 10.0% in urban hospitals in 2010. Between 2002 and 2010, rates of low-risk cesarean and nonindicated cesarean increased, and VBAC rates decreased in both rural and urban hospitals. Nonindicated labor induction was less frequent in rural versus urban hospitals in 2002 [adjusted odds ratio=0.79 (0.78-0.81)], but increased more rapidly in rural hospitals from 2002 to 2010 [adjusted odds ratio=1.05 (1.05-1.06)]. In 2010, 16.5% of rural births were induced without indication (12.0% of urban births).Conclusions:From 2002 to 2010, cesarean rates rose and VBAC rates fell in both rural and urban hospitals. Nonindicated labor induction rates rose disproportionately faster in rural versus urban settings. Tailored clinical and policy tools are required to address differences between rural and urban hospitals.