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Associations of spatial accessibility to maternity care services and adverse pregnancy outcomes

Minion, Sarah (2023) Associations of spatial accessibility to maternity care services and adverse pregnancy outcomes. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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The decline of accessible maternity care services is a growing concern in the United States (U.S.). Currently, over 2 million reproductive-aged women live in U.S. counties without any hospitals providing obstetric care, birth centers, or obstetric care providers.1 We used a geocoded, population-based cohort of Pennsylvania birth records from 2011-2015 to study whether spatial accessibility to maternity care services was associated with adverse pregnancy outcomes. We explored (i) accessibility to obstetricians and prenatal care utilization adequacy; (ii) distance to delivery hospital and adverse pregnancy outcomes; and finally, (iii) accessibility and availability to hospital-based obstetric care and adverse pregnancy outcomes. Our results provide evidence of a direct association between spatial accessibility to maternity care services and adverse pregnancy outcomes. We found that regardless of rurality, a higher number of obstetricians per 1,000 mothers in a 15 km radius of residence was associated with more cases of adequate prenatal care utilization. For every 100 women, urban women with ≥30 obstetricians had 7.0 (95% CI: 6.3–7.8) more cases of adequate prenatal care and rural women had 2.4 (95% CI: 0.2–4.7) more cases compared to the reference category of <5 obstetricians. We found that compared to driving only 1 km to the delivery hospital, increasing driving distance was significantly associated with increased adjusted risks of maternal morbidity (aRR: 1.53 (95% CI: 1.31-1.75) at 80 km), NICU admission (aRR: 2.25 (95% CI: 2.18-2.33) at 80 km), PTB (aRR: 1.74 (95% CI: 1.68, 1.80) at 80 km) and small-for-gestational age (SGA) (aRR: 1.19 (95% CI: 1.14, 1.24) at 80 km). Finally, in a 4-class latent class analysis, we found that women with shorter distances to the nearest hospital and increasing number of hospitals in a 30-km radius had lower risks of SGA and maternal morbidity and higher risks of NICU admission compared to those with the lowest spatial accessibility. The findings from this dissertation are important to public health, because maternity care service accessibility is a potentially modifiable risk factor for which solutions to improve healthcare, pregnancy outcome, and neonatal health disparities could be targeted.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Minion, Sarahscm63@pitt.eduscm630000-0003-4144-6888
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairHaggerty, Catherinehaggertyc@pitt.eduhaggertyc
Committee MemberBrooks, Mariambrooks@pitt.edumbrooks
Committee MemberKrans,
Committee MemberMendez, DaraDDM11@pitt.eduDDM11
Date: 19 May 2023
Date Type: Publication
Defense Date: 11 April 2023
Approval Date: 19 May 2023
Submission Date: 28 April 2023
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 161
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: spatial accessibility, maternal and child health, healthcare disparities
Date Deposited: 19 May 2023 19:47
Last Modified: 12 Jun 2023 17:11


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