SEARCHCROSS-SECTIONALobstetrics, gynecology

cross-sectional·obstetrics, gynecology, neonatology, public health, epidemiology, rural health, maternal-fetal medicine, pediatrics·PMC10122232

Perinatal Health Outcomes Across Rural and Nonrural Counties Within a Single Health System Catchment

Women's Health Reports · 13 authors, 5 centres

AI SUMMARY

FIDELITY 100%

POPULATIONResidents of 13 Florida counties (10 rural, 3 nonrural) within the UF Health Perinatal Catchment Area, representing 64,294 live births between June 2011 and April 2017

INTERVENTIONNot applicable (observational, cross-sectional analysis of county-level data)

COMPARISONRural versus nonrural counties within the UFHPCA; also compared to statewide Florida rates

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

This study defined the University of Florida Health Perinatal Catchment Area (UFHPCA) as 13 Florida counties (10 rural, 3 nonrural) representing over 64,000 deliveries. Rural counties within the catchment had significantly higher maternal smoking rates (53% higher), higher preterm birth rates (16% higher), lower breastfeeding initiation (89% of nonrural), and severely limited access to obstetric providers—7 of 13 counties had no licensed OB-GYN. These findings highlight critical perinatal health disparities and the need for targeted interventions addressing social determinants of health in rural communities.

Full summary

3,917 CHARS

**Background:** Adverse perinatal health outcomes, including maternal and infant mortality, are substantially higher in the United States compared with other wealthy nations. Rural communities face particular barriers including lack of resources and fragmentation of health services. Up to 90% of rural/urban differences in perinatal health outcomes are attributed to nonclinical social determinants of health (SDoH) such as education, income, and access to care. This study aimed to evaluate patterns in health outcomes, health behaviors, socioeconomic vulnerability, and sociodemographic characteristics across rural and nonrural counties within a single health system catchment area.

**Methods:** The University of Florida Health Perinatal Catchment Area (UFHPCA) was defined using electronic health records from UF Health Shands Hospital for all live births between June 2011 and April 2017. Counties where ≥5% of all county births occurred at UF Health were included. Socioeconomic vulnerability metrics, health care access data (licensed provider metrics), and behavioral data were obtained from FlHealthCHARTS.gov and the County Health Rankings. County-level birth and perinatal health outcome data came from the Florida Department of Health. Rurality was defined per Florida Statutes 288.0656 (population ≤75,000, or ≤125,000 if contiguous to a county <75,000). Risk ratios comparing rural versus nonrural counties within the UFHPCA were calculated for each measure.

**Key Results:** The UFHPCA included 13 counties (3 nonrural: Alachua, Citrus, Marion; 10 rural: Putnam, Bradford, Columbia, Union, Suwannee, Gilchrist, Levy, Hamilton, Dixie, Lafayette), representing 64,294 live births, with 32.5% (20,899) from rural counties. Twelve of 13 counties had a positive health outcomes z-score indicating high health burden. Seven of 13 counties had no licensed OB-GYN. Maternal smoking rates across the catchment ranged from 6.8% to 24.8%, all above the statewide rate of 6.2%. Only Alachua County (84.6%) had a breastfeeding initiation rate above the statewide rate of 82.9%; remaining counties ranged from 54.9% to 81.4%. Preterm birth rates (9.0–13.1 per 1,000 live births) exceeded the statewide rate of 10.1 in 10 of 13 counties. Childhood poverty rates (16.3%–36.9%) exceeded the statewide rate of 18.5% in all counties except Columbia (17.6%) and Suwannee (16.3%). Computing device access (72.8%–86.4%) was below the statewide rate of 87.9% in all counties except Alachua (89.0%). Risk ratios showed statistically significant disparities: breastfeeding initiation in rural counties was 89% of nonrural (RR 0.89, 95% CI 0.88–0.91); family physicians were 36% (RR 0.36, 95% CI 0.31–0.42); pediatricians 15% (RR 0.15, 95% CI 0.12–0.19); OB-GYNs 24% (RR 0.24, 95% CI 0.19–0.31). Maternal smoking was 53% higher in rural counties (RR 1.53, 95% CI 1.48–1.59), and preterm birth was 16% higher (RR 1.16, 95% CI 1.10–1.21). Infant mortality (RR 1.06, 95% CI 0.90–1.25) and maternal deaths (RR 1.04, 95% CI 0.39–2.78) were not statistically significant due to small sample sizes.

**Clinical Implications:** This study demonstrates that the UFHPCA bears a disproportionate perinatal health burden characterized by higher maternal and infant mortality, higher smoking during pregnancy, lower breastfeeding initiation, and severe shortages of obstetric providers—particularly in rural counties. Seven of 13 counties lacked any licensed OB-GYN, effectively constituting perinatal health care deserts. The findings underscore the need for precision public health interventions including telemedicine expansion, maternal safety bundles, and targeted smoking cessation and breastfeeding support programs. Delineating the catchment area enables researchers and policymakers to focus resources on the highest-need communities and facilitates collaborations with nonprofits and policymakers to address health disparities.

PICO

PPOPULATION

Residents of 13 Florida counties (10 rural, 3 nonrural) within the UF Health Perinatal Catchment Area, representing 64,294 live births between June 2011 and April 2017

IINTERVENTION

Not applicable (observational, cross-sectional analysis of county-level data)

OOUTCOME

Maternal mortality, neonatal mortality, preterm birth, maternal smoking during pregnancy, breastfeeding initiation, childhood poverty rates, household computing device access, and licensed provider density (pediatricians, OB-GYNs, family practice physicians)

STUDY TYPE

cross-sectional

SPECIALTY

obstetrics

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10122232

Perinatal Health Outcomes Across Rural and Nonrural Counties Within a Single Health System Catchment

Women's Health Reports

READ THE FULL PAPER

ABSTRACT

Background: Perinatal health outcomes are influenced by a variety of socioeconomic, behavioral, and economic factors that reduce access to health services. Despite these observations, rural communities continue to face barriers, including a lack of resources and the fragmentation of health services. Objective: To evaluate patterns in health outcomes, health behaviors, socioeconomic vulnerability, and sociodemographic characteristics across rural and nonrural counties within a single health system catchment area. Methods: Socioeconomic vulnerability metrics, health care access as determined by licensed provider metrics, and behavioral data were obtained from FlHealthCHARTS.gov and the County Health Rankings. County-level birth and health data were obtained from the Florida Department of Health. The University of Florida Health Perinatal Catchment Area (UFHPCA) was defined as all Florida counties where ≥5% of all infants were delivered at Shands Hospital between June 2011 and April 2017. Results: The UFHPCA included 3 nonrural and 10 rural counties that represented more than 64,000 deliveries. Nearly 1 in 3 infants resided in a rural county, and 7 out of 13 counties did not have a licensed obstetrician gynecologist. Maternal smoking rates (range 6.8%–24.8%) were above the statewide rate (6.2%). Except for Alachua County, breastfeeding initiation rates (range 54.9%–81.4%) and access to household computing devices (range 72.8%–86.4%) were below the statewide rate (82.9% and 87.9%, respectively). Finally, we found that childhood poverty rates (range 16.3%–36.9%) were above the statewide rate (18.5%). Furthermore, risk ratios suggested negative health outcomes for residents of counties within the UFHPCA for each measure, except for infant mortality and maternal deaths, which lacked sample sizes to adequately test. Conclusions: The health burden of the UFHPCA is characterized by rural counties with increased maternal death, neonatal death, and preterm birth, as well as adverse health behaviors that included increased smoking during pregnancy and lower levels of breastfeeding relative to nonrural counties. Understanding perinatal health outcomes across a single health system has potential to not only estimate community needs but also facilitate planning of health care initiatives and interventions in rural and low-resource communities.

CITATION EXPORT

Dominick J. Lemas, Claire Layton, Hailey Ballard et al.. Perinatal Health Outcomes Across Rural and Nonrural Counties Within a Single Health System Catchment. Women's Health Reports. (2023). https://doi.org/10.1089/whr.2022.0061

AUTHORS

13 · 5 CENTRES

Dominick J. Lemas, Claire Layton, Hailey Ballard, Ke Xu, John C. Smulian, Matthew Gurka, Matthew Shane Loop, Erica L. Smith, Callie F. Reeder, Adetola Louis-Jacques, Chu J. Hsiao, Nicole Cacho, Jaclyn Hall

1Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA.
2Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, Florida, USA.
3Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
4Department of Anthropology, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida, USA.
5Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, USA.