Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the United States.

ABSTRACT:

Importance

Hospital-based obstetric services have decreased in rural US counties, but whether this has been associated with changes in birth location and outcomes is unknown.

Objective

To examine the relationship between loss of hospital-based obstetric services and location of childbirth and birth outcomes in rural counties.

Design, setting, and participants

A retrospective cohort study, using county-level regression models in an annual interrupted time series approach. Births occurring from 2004 to 2014 in rural US counties were identified using birth certificates linked to American Hospital Association Annual Surveys. Participants included 4 941 387 births in all 1086 rural counties with hospital-based obstetric services in 2004.

Exposures

Loss of hospital-b

SUBMITTER: Kozhimannil KB 

PROVIDER: S-EPMC5885848 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature