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

Abstract

<b>Objectives.</b> To describe differences in maternal admissions to the intensive care unit (ICU) and mortality in rural versus urban areas in the United States. <b>Methods.</b> 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. <b>Results.</b> 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). <b>Conclusions.</b> 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. <b>Public Health Implications.</b> Public health efforts need to focus on resource-limited rural areas to mitigate geographic disparities in maternal morbidity and mortality. (<i>Am J Public Health.</i> 2023;113(2): 224-227.https://doi.org/10.2105/AJPH.2022.307134).