作者
Katy B Kozhimannil, Peiyin Hung, Carrie Henning-Smith, Michelle M Casey, Shailendra Prasad
发表日期
2018/3/27
期刊
Jama
卷号
319
期号
12
页码范围
1239-1247
出版商
American Medical Association
简介
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-based obstetric services in the county of maternal residence, stratified by adjacency to urban areas.
Main Outcomes and Measures
Primary outcomes were …
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