Associations between maternal residential rurality and maternal health, access to care, and very low birthweight infant outcomes

Objective Infant mortality is increased in isolated rural areas. This study compares prenatal factors, access to care, and health outcomes for very-low birthweight (VLBW) infants by degree of maternal residential rurality. Methods This descriptive population-based retrospective cohort study used the California Perinatal Quality Care Collaborative registry to study VLBW infants. Rurality was assigned as urban, large rural, and small rural/isolated using the Rural Urban Commuting Area codes. We used hierarchical random effect models to test the association of rurality with survival without major morbidity. Results The study included 38 614 dyads. VLBW survival without major morbidity decreased with increasing rurality and the relationship remained significant for small rural/isolated areas (OR 0.79, p = 0.03) after adjustment. Birth weight, gestational age, and infant sex were similar across geographic groups. Conclusion A rural urban disparity exists for VLBW survival without major morbidity. Our findings generate hypotheses about factors that may be driving these disparities.