Health Equity/Community Health
Poster Session 4
Charlotte McCarley, MD (she/her/hers)
Fellow
University of Alabama at Birmingham
Hoover, AL, United States
Christina T. Blanchard, MS
Statistician
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, AL, United States
Ariann Nassel, MA
Director of Geospatial Data Visualization
School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Birmingham, AL, United States
Ashley N. Battarbee, MD, MSCR
Assistant Professor
University of Alabama at Birmingham
Birmingham, AL, United States
Akila Subramaniam, MD, MPH (she/her/hers)
Associate Professor
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, AL, United States
Maternal care deserts are increasing. We evaluated if driving distance to obstetric (OB) care is associated with perinatal morbidity and if this association differs based on social vulnerability.
Study Design:
Retrospective cohort of patients delivering a singleton ≥ 22 weeks at a tertiary care center in central Alabama (2014-2018). Patients were excluded if their home address was unavailable or outside Alabama. Driving distance from home address to the nearest OB center and our center was determined using ArcGIS Network Analyst. Patients were secondarily categorized by their social vulnerability index (SVI); high SVI defined as 1 standard deviation above our population mean. Co-primary outcomes were composites of adverse maternal and neonatal outcomes (Table). The odds of our outcomes by driving distance (kilometers) to nearest OB center and our center were estimated using logistic regression models. Tests of interaction explored differential effects on outcomes by SVI (high SVI vs. not).
Results:
A total of 12,697 patients were analyzed: 65% publicly insured, 46% Non-Hispanic Black, and 60% single. Median driving distance to nearest OB center was 11km (IQR 6-21) and to our center 19km (10-34). The maternal composite occurred in 32% and neonatal composite in 25% of our cohort. There was no association between driving distance to nearest OB center for either outcome in the overall cohort (Table). In the subgroup of patients with high SVI (n=2885) there was a 2.5-fold increased odds of neonatal morbidity (aOR 2.51 [95% CI 1.60-3.94]) for every 50km further from the nearest OB center. When examining distance to our center, there was a 5% increased odds of maternal and a 25% increased odds of neonatal morbidity for every 50km further from our center (Table); results did not differ by SVI.
Conclusion:
Patients living further from our tertiary care center have higher odds of maternal and neonatal morbidity regardless of SVI. Additionally, living further from the nearest OB center increases neonatal morbidity for those with high SVI. Interventions for high SVI patients living in remote areas are needed.