(906) Rurality is associated with increased risk for severe maternal morbidity among socially vulnerable communities

To evaluate the association between severe maternal morbidity (SMM) and rural residence among communities of high social vulnerability.

Study Design:

We performed a retrospective cohort study using California’s linked vital statistics-hospital discharge data (2018-2020). The study population composed of individuals with singleton, non-anomalous pregnancies delivered between 20-44 weeks’ gestation with maternal residence (at time of birth) in communities deemed high on the Center for Disease Control’s (CDC) Social Vulnerability Index (SVI) in 2020. Our primary outcome was a composite of SMM, defined using the CDC’s published list of 21 indicators. Multivariable Poisson regression was used to calculate an adjusted risk ratio to assess whether rural residence in socially vulnerable communities was associated with SMM.

Results:

Of the 605,301 births meeting inclusion criteria, 38,350 (6.3%) were from rural California. Rural Californians were more likely to be Non-Hispanic White (34.2% vs 21.8%), less 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%). Compared to urban centers, the prevalence of SMM was greater in rural communities of high SVI (1.75% vs. 1.46%, p< 0.001). The indicator with the highest proportion was maternal blood transfusion (1.5% for rural, 1.1% for urban, p< 0.001). There was an increased risk of SMM in rural communities after adjusting for maternal race/ethnicity, age, education, insurance, parity, and preexisting diabetes and hypertension (aRR 1.21; 1.12-1.31).

Conclusion:

SVI reflects a community-level resilience for combating external stressors. Our findings suggest that individuals from rural communities with high social vulnerability may face additional disadvantages compared to their urban counterparts. More research is needed to explore the root causes of rural maternal disparities, so we may design meaningful interventions to optimize the health of our rural patients.