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The objective of this study was to determine how preterm delivery rates differ in a country with a very high human development index and to explore rural vs urban environmental and socioeconomic factors that may be responsible for this variation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>A population\u2010based study was performed using data from the Swedish Medical Birth Register from 1998 to 2013. Sweden was chosen as a model because of its validated, routinely collected data and availability of individual social data. The total population comprised 1\u00a0335\u00a0802 singleton births. A multiple linear regression was used to adjust gestational age for known risk factors (maternal smoking, ethnicity, maternal education, maternal age, height, fetal sex, maternal diabetes, maternal hypertension, and parity). A second and a third model were subsequently fitted allowing separate intercepts for each municipality (as fixed or random effects). Adjusted gestational ages were converted to preterm delivery rates and mapped onto maternal residential municipalities. Additionally, the effects of six rural vs urban environmental and socioeconomic factors on gestational age were tested using a simple weighted linear regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study population preterm delivery rate was 4.12%. Marked differences from the overall preterm delivery rate were observed (rate estimates ranged from 1.73% to 6.31%). The statistical significance of this heterogeneity across municipalities was confirmed by a chi\u2010squared test (<jats:italic>P<\/jats:italic>\u00a0&lt; 0.001). Around 20% of the gestational age variance explained by the full model (after adjustment for known variables described above) could be attributed to municipality\u2010level effects. In addition, gestational age was found to be longer in areas with a higher fraction of built\u2010upon land and other urban features.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>After adjusting for known risk factors, large geographical differences in rates of preterm delivery remain. Additional analyses to look at the effect of environmental and socioeconomic factors on gestational age found an increased gestational age in urban areas. Future research strategies could focus on investigating the urbanity effect to try to explain preterm delivery variation across countries with a very high human development index.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13455","type":"journal-article","created":{"date-parts":[[2018,8,31]],"date-time":"2018-08-31T16:21:01Z","timestamp":1535732461000},"page":"106-116","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Geographical differences in preterm delivery rates in Sweden: A population\u2010based cohort study"],"prefix":"10.1111","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2344-6852","authenticated-orcid":false,"given":"Sarah R.","family":"Murray","sequence":"first","affiliation":[{"name":"MRC Centre for Reproductive Health, Queen\u2019s Medical Research Institute, University of Edinburgh Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julius","family":"Juodakis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas","family":"Bacelis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Sand","sequence":"additional","affiliation":[{"name":"Karolinska University Hospital Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane E.","family":"Norman","sequence":"additional","affiliation":[{"name":"MRC Centre for Reproductive Health, Queen\u2019s Medical Research Institute, University of Edinburgh Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Verena","family":"Sengpiel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5079-2374","authenticated-orcid":false,"given":"Bo","family":"Jacobsson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden"},{"name":"Department of Genetics and Bioinformatics, Area of Health Data and Digitalization Norwegian Institute of Public Health Oslo Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,10,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61856-X"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60820-4"},{"key":"e_1_2_10_4_1","volume-title":"Preterm birth: causes, consequences, and prevention","author":"Behrman RE","year":"2007"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2003.043851"},{"key":"e_1_2_10_6_1","volume-title":"Born too soon: the global action report on preterm birth","author":"World Health Organization","year":"2012"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0162506"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60074-4"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0060660"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i5206"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2015.05.010"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envpol.2017.03.055"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.6251"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1758-5899.2011.00147.x"},{"key":"e_1_2_10_15_1","unstructured":"Swedish Official Statistics.Pregnancies deliveries and newborn babies.2015.https:\/\/www.socialstyrelsen.se\/Lists\/Artikelkatalog\/Attachments\/20009\/2015-12-27.pdf. 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