Effect of Losing Hospital-Based Obstetric Services on Maternal Health in Rural Communities

项目摘要/摘要 在美国，在获得以医院为基础的产科护理方面存在显著的城乡差距，而且 城市和农村社区之间的准入差距正在扩大。获得以医院为基础的产科服务 保健对孕前、孕中和孕后的健康结果至关重要。重度孕产妇死亡率 在美国，发病率和孕产妇死亡率正在上升，尤其是生活在农村社区的母亲。 我们对缺乏以医院为基础的产科护理是否会在不良反应中发挥作用知之甚少。 农村地区的孕产妇结局。这项研究有两个目标。首先，我们估计了损失的影响 美国农村县获得以医院为基础的产科护理的情况--对孕产妇健康结果的衡量 在分娩时，并按种族/民族和母亲教育测试差异，使用VITAL 统计2005-2018年出生证明记录。其次，我们估计了政策的规模- 直接或间接影响农村母亲健康结局的相关因素 获得产科护理；这些与政策相关的因素包括该州扩大ACA医疗补助 现状、医院特色、地方市场特色。这些发现旨在提供 关于关闭乡村医院和产科单元的健康后果以及如何 公共政策可以用来抵消一些影响。

Project Summary / Abstract There are striking urban/rural disparities in access to hospital-based obstetric care in the US, and the gap in access between urban and rural communities is growing. Access to hospital-based obstetric care is critical to health outcomes before, during, and after pregnancy. Rates of severe maternal morbidity and maternal mortality are rising in the US, particularly for mothers living in rural communities. We know little about whether lack of access to hospital-based obstetric care may play a role in adverse maternal outcomes in rural areas. This study has two goals. First, we estimate the effect of losing access to hospital-based obstetric care in rural U.S. counties on maternal health outcomes measured at the time of delivery, and test for disparities by race/ethnicity and by maternal education, using Vital Statistics birth certificate records from 2005-2018. Second, we estimate the magnitudes of policy- relevant factors affecting rural mothers’ health outcomes directly as well as indirectly through loss of access to obstetric care; these policy-relevant factors include the state’s ACA Medicaid expansion status, hospital characteristics, and local market characteristics. These findings are intended to provide new information on the health consequences of rural hospital and obstetric unit closures, and how public policies can be used to offset some of the impact.