(907) Rurality is associated with decreased risk for adverse neonatal outcomes among socially vulnerable communities

To assess the relationship between rural residence and adverse neonatal outcomes among socially vulnerable communities.

Study Design:

This is a retrospective cohort study using California’s linked vital statistics-hospital discharge data (2018-2020). Our study population included all singleton, non-anomalous pregnancies delivered between 20-44 weeks’ gestation with maternal residence in communities deemed high on the Center for Disease Control’s (CDC) Social Vulnerability Index (SVI). The outcome of interest was an adverse neonatal composite including preterm delivery, neonatal intensive care unit (NICU) admission, small for gestational age, low birth weight, seizures, birth injury, and neonatal sepsis. Adjusted risk ratios were calculated using multivariable Poisson regression to assess whether rural residence in socially vulnerable communities was associated with the neonatal composite.

Results:

Of the 605,301 births within high SVI communities, 38,350 (6.3%) were from rural California. The rural cohort were more likely to be Non-Hispanic White (34.2% vs 21.8%), younger than 20 years of age (6.4% vs 4.3%), publicly insured (71.2% vs. 55.9%) and have an education level of high school or below (54.1% vs 41.9%). The adverse neonatal composite was significantly higher among urban communities compared to their rural counterparts (23.8% vs 21.8%, P< 0.001). After adjusting for maternal race/ethnicity, age, education level, insurance status, parity, and preexisting diabetes and hypertension, the risk of the adverse neonatal composite was lower among the rural cohort (aRR= 0.94; 95% CI: 0.92-0.95).

Conclusion:

Social Vulnerability measures a community’s ability to face external stressors and public health emergencies. Our analysis suggests that rural communities with high SVI may have protective factors that positively impact reproductive outcomes compared to their urban counterparts. However, more research is needed to better understand disparities in health outcomes between rural and urban birthing individuals.