More rural women return to hospital after giving birth

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New mothers who live in rural areas are more likely to be re-hospitalized within 30 days of giving birth than women who live in cities are, new research shows.

Past research has shown that people living in rural areas are less likely to receive screening for colorectal cancer, more likely to die of unintentional injuries, and more likely to be physically inactive and overweight.

For the new study, researchers looked at the records of nearly half a million women who gave birth in California in 2011 to see if there was a difference in re-hospitalization rates. The findings, published in the journal Rural and Remote Health, show that women who gave birth in a rural hospital were more likely to be readmitted to the hospital within 30 days, even after adjusting for factors like age, race, and payment method (Medicaid versus private insurance).

“It was a small, but still statistically significant, effect,” says Robert L. Ohsfeldt, professor in the School of Public Health at Texas A&M University. The overall readmission rate for women with a vaginal delivery was less than 1 percent, and it was about 1.41 percent for women who delivered by cesarean sections. Regardless of the delivery mode, the rural population who gave birth in rural hospitals—as the majority of rural residents did—had a 10 percent higher readmission rate compared to the urban population.

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Reimbursement rates for Medicaid and Medicare are tied to readmission rates, but no one had previously studied how new mothers might be affected.

These findings are especially important as maternal death rates in the United States are actually on the rise. Mortality rate in the US is higher than Iran or Libya. In Texas, the rate doubled in just the two years between 2010 and 2012. Although hospital readmission may not be directly correlated with maternal deaths, the study does hint at possible areas that need further attention.

“Maybe women from rural areas should be managed more carefully because they might be at higher risk of readmission,” Ohsfeldt says.

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Although the study only looks at one state, and the results might not apply everywhere in the country, researchers are confident about their choice of data.

“There are lots of people in California, and therefore lots of data,” Ohsfeldt says. The massive amount of data is required to detect meaningful differences about relatively rare events. The researchers also believe that California can serve as a fairly good model. “California’s also a very diverse state, so I wouldn’t be as concerned about there being some effect unique to California as I would in some states with more uniform populations,” Ohsfeldt says.

The reason for the differences is unclear, but the researchers speculate they might be due to poorer access to prenatal care and issues of transportation to and from a hospital or obstetrician’s office. Those issues might be especially compounded due to the relative lack of ob-gyns in rural areas, where there are about two for every 1,000 residents. The ratio in urban areas is 35 obstetricians to every 1,000 residents.

“We already knew that people who live in rural areas have more limited access to health resources,” Ohsfeldt says, “and this suggests an additional consequence of that.”

Source: Texas A&M University