413: Rurality as a contemporary risk factor for severe maternal morbidity

Abstract

The purpose of this study is to appreciate whether rurality and region influence the risk of severe maternal morbidity (SMM) while controlling for previously established risk factors such as chronic illness, substance abuse, race, and age. The dataset includes de-identified discharge information of 50,784 hospitalizations at the time of delivery from all inpatients in Kentucky in 2017. The delivery hospitalization was the unit of analysis. We used a multivariate logistic regression model to analyze the likelihood that a woman experienced SMM. SMM was defined by CDC ICD-10-CM criteria, which include 18 categories of diagnostic and procedural indicators, such as cardiac arrest or need for blood transfusion. Patients’ home county was utilized to determine women’s rurality and region of residence. Of all hospitalizations at the time of delivery, 1.50% exhibited SMM, which is greater than the national rate of 1.44%. Counties in rural Appalachia experienced rates of SMM as high as 8.5%, see Figure. As expected, Black women, women with hypertension, opioid use disorder, obesity, anemia or a previous cesarean section experienced an increased odds of SMM, see Table 1. Rural women and Appalachian women were at increased risk. When controlling for all other independent variables, the odds for women living in rural counties was 1.84 (95% CI 1.42, 2.42) the odds of women living in metro counties, and 1.30 (95% CI 1.01, 1.67) the odds of women living in counties adjacent to metro centers. The odds of Appalachian women experiencing SMM was 1.47 (95% CI 1.12, 1.86) the odds of Central Kentucky women. Rural women and women in Appalachia experience an increased odds of SMM. To address SMM, programming focused on the management of hypertension and opioid use disorder may provide opportunities for improvement. Programming addressing quality and safety in our state or states with similar isolated subpopulations should also consider translational efforts aimed at rural populations.View Large Image Figure ViewerDownload Hi-res image Download (PPT)