Rural–Urban Disparities in Adverse Maternal Outcomes in the United States, 2016–2019

Abstract

Objectives. To describe differences in maternal admissions to the intensive care unit (ICU) and mortality in rural versus urban areas in the United States. Methods. We performed a nationwide analysis and calculated age-standardized rates and rate ratios (RRs) of maternal ICU admission and mortality per 100 000 live births between 2016 and 2019 in rural versus urban areas. Results. From 2016 to 2019, there was no significant increase in age-standardized rates of maternal ICU admissions in rural (170.6–192.3) or urban (161.7–172.4) areas, with a significantly higher rate, albeit a relatively small difference, in rural versus urban areas (2019 RR = 1.14; 95% confidence interval [CI] = 1.04, 1.20). Maternal mortality increased in both rural (66.9–81.7 deaths per 100 000 live births) and urban (38.1–42.3) areas and was nearly 2 times higher in rural areas (2019 RR = 1.93; 95% CI = 1.71, 2.17). Conclusions. Pregnant individuals in rural areas are at higher risk for ICU admission and mortality than are their urban counterparts. Significant increases in maternal mortality occurred in rural and urban areas. Public Health Implications. Public health efforts need to focus on resource-limited rural areas to mitigate geographic disparities in maternal morbidity and mortality. (Am J Public Health. 2023;113(2): 224–227. https://doi.org/10.2105/AJPH.2022.307134 )

Nationwide study of in-hospital maternal mortality in Ecuador, 2015–2022

“…Furthermore, this study found that ethnic minorities in the category “other” had higher rates of in-hospital delivery-related maternal mortality, which is in line with other studies that had reported higher risks among ethnic and social minorities ( 7 , 8 , 14 ). The results from this study revealed a bivariate association between rural areas and a higher probability of maternal death, but unlike other studies ( 6 , 15 ), this study did not find a significant association in the multivariate analysis. Preconception care seems to play an important role in addressing disparities in maternal health care since this helps to screen vulnerable and high-risk groups ( 16 ).…”

“…However, it is essential to recognize that this pandemic is but one piece of a complex puzzle. While the COVID-19 pandemic may have played a role, multiple interrelated factors -including demographic disparities, socioeconomic inequalities, comorbidities, clinical complications and other determinants of health -may have contributed to the complexity of trends in maternal mortality (5)(6)(7)(8). In light of the lack of evidence about the current state of in-hospital maternal mortality in Ecuador, this study aimed to analyze in-hospital delivery-related maternal mortality and the sociodemographic factors influencing maternal mortality.…”

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…In a nationwide analysis between 2016 and 2019, pregnant females from rural areas were at greater risk for maternal ICU admission (RR, 1.14 [95% CI, 1.04–1.20]) and maternal mortality (RR, 1.93 [1.71–2.17)] compared with their urban counterparts. 41…”

The evolution of health system planning and implementation of maternal telehealth services during the COVID-19 Pandemic

“…Higher maternal mortality and morbidity have been reported among people living in rural and underserved areas, including Black, Indigenous, and low-income people. 1 – 4 These outcomes are partly attributable to inequitable distributions of health-enabling resources and environments (e.g., safe work conditions; residential contexts across the life course), 1 , 5 – 13 which affect a wide range of health, functioning, and quality-of-life outcomes. 14 This includes inequities in healthcare access and quality of care, economic stability, and social needs (e.g., housing, social support, transportation, employment).…”