{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T06:22:02Z","timestamp":1783405322315,"version":"3.54.6"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T00:00:00Z","timestamp":1727913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Hospital-based labor and delivery units are closing at increasing rates in the rural US, significantly impacting maternal and newborn health. The objective of this study to determine if rurality\u2014measured as distance from the hospital\u2014and socioeconomic status\u2014measured as insurance payor\u2014impact both spontaneous and medically indicated preterm birth incidence at a single rural academic institution.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a retrospective cohort study using electronic medical records of patients with singleton pregnancies delivering at a single rural academic institution between 2016\u20132018. The primary outcome was preterm delivery (PTD) and secondary outcomes included low birth weight (LBW) and intensive care nursery (ICN) admission. The primary exposures included (1) travel time from a patient\u2019s address to the hospital and (2) insurance carrier as a proxy for socioeconomic status. Bivariate analyses indicated that travel time, insurance status, race, ethnicity, marital status, number of prenatal visits, gravida and para, and smoking status were significant predictors of all outcomes (LBW, ICN admission, and PTD). Therefore, these predictors were included in the multivariable logistic models.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Within the multivariable logistic model, patients traveling 1\u20131.5 hours had approximately twice the odds of PTD (Odds Ratio, OR: 2.08, 95% Confidence Interval CI, 1.32, 3.29, p = .002), birth of a LBW neonate (OR: 2.15; 95% CI: 1.29\u20133.58, <jats:italic>p<\/jats:italic> = .005), and infant admission to the ICN (OR 1.83, 95% CI: 1.22\u20132.76, <jats:italic>p<\/jats:italic> = .004) compared to patients traveling under 30 minutes,. Insurance carrier status was not associated with increased odds of PTD, LBW, or ICN admission.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Patients living 1-to-1.5 hours from the hospital had an increased risk for LBW, ICN admission, and PTD, despite living in zip codes with less social deprivation than zip codes further away from the hospital.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0306859","type":"journal-article","created":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T17:32:39Z","timestamp":1727976759000},"page":"e0306859","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Multivariable modeling: A retrospective cohort study exploring the impact of socioeconomic status and distance to a rural academic center on all-cause preterm delivery"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4229-8274","authenticated-orcid":true,"given":"Shilpa","family":"Darivemula","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn","family":"Kouassi-Brou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Pollack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1233-2400","authenticated-orcid":true,"given":"Amy","family":"Paris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy","family":"Goodman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0146-6956","authenticated-orcid":true,"given":"Timothy","family":"Fisher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,10,3]]},"reference":[{"issue":"5","key":"pone.0306859.ref001","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.ajog.2015.11.030","article-title":"Location of childbirth for rural women: implications for maternal levels of care","volume":"214","author":"KB Kozhimannil","year":"2016","journal-title":"American journal of obstetrics and gynecology"},{"key":"pone.0306859.ref002","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1007\/s10995-018-2500-7","article-title":"Racial\/ethnic inequities in low birth weight and preterm birth: the role of multiple forms of stress","volume":"22","author":"J Almeida","year":"2018","journal-title":"Maternal and child health journal"},{"key":"pone.0306859.ref003","unstructured":"Behrman RE, Butler AS. Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes, eds. Preterm Birth: Causes, Consequences, and Prevention. 2007."},{"key":"pone.0306859.ref004","unstructured":"Maternal and infant health. Centers for Disease Control and Prevention. 2022, Jan 27 [Cited 2023 January 27]. Available from: https:\/\/www.cdc.gov\/reproductivehealth\/maternalinfanthealth\/index.html."},{"issue":"9","key":"pone.0306859.ref005","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1377\/hlthaff.2017.0338","article-title":"Access to obstetric services in rural counties still declining, with 9 percent losing services, 2004\u201314","volume":"36","author":"P Hung","year":"2017","journal-title":"Health Affairs"},{"issue":"12","key":"pone.0306859.ref006","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1001\/jama.2018.1646","article-title":"Eroding access and quality of childbirth care in rural US counties","volume":"319","author":"NT Shah","year":"2018","journal-title":"JAMA"},{"issue":"12","key":"pone.0306859.ref007","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1001\/jama.2018.1830","article-title":"Association between loss of hospital-based obstetric services and birth outcomes in rural counties in the United States","volume":"319","author":"KB Kozhimannil","year":"2018","journal-title":"Jama"},{"issue":"5","key":"pone.0306859.ref008","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.ajog.2015.11.030","article-title":"Location of childbirth for rural women: implications for maternal levels of care","volume":"214","author":"KB Kozhimannil","year":"2016","journal-title":"American journal of obstetrics and gynecology"},{"key":"pone.0306859.ref009","volume-title":"Labor and Delivery Unit Closures in Rural New Hampshire. Urban Institute. Accessed at: Labor and Delivery Unit Closures in Rural New Hampshire","author":"David LaFlamme"},{"key":"pone.0306859.ref010","unstructured":"McMorrow S, Benatar S, Fisher T. Labor and delivery unit closures in rural New Hampshire. InAPHA\u2019s 2020 VIRTUAL Annual Meeting and Expo (Oct. 24\u201328) 2020 Oct 28. APHA."},{"key":"pone.0306859.ref011","unstructured":"LaFlamme, David. North New England Birth Hospital Closures Map. Tableau. Published November 2022. Updated January 2023."},{"issue":"3","key":"pone.0306859.ref012","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1097\/AOG.0b013e318242b4cb","article-title":"Drive times to hospitals with perinatal care in the United States","volume":"119","author":"WF Rayburn","year":"2012","journal-title":"Obstetrics & Gynecology"},{"issue":"1","key":"pone.0306859.ref013","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1111\/jrh.12677","article-title":"Urban\u2010rural disparities in childhood obesogenic environments in the United States: Application of differing rural definitions","volume":"39","author":"ME Wende","year":"2023","journal-title":"The Journal of Rural Health"},{"key":"pone.0306859.ref014","unstructured":"Cromartie, John. Rural-Urban Commuting Area (RUCA) Codes. USDA Economic Research Service. Updated March 2023. https:\/\/www.ers.usda.gov\/data-products\/rural-urban-commuting-area-codes\/documentation\/."},{"issue":"2","key":"pone.0306859.ref015","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1111\/j.1475-6773.2012.01449.x","article-title":"Measures of social deprivation that predict health care access and need within a rational area of primary care service delivery","volume":"48","author":"DC Butler","year":"2013","journal-title":"Health services research"},{"issue":"1","key":"pone.0306859.ref016","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1472-6963-11-147","article-title":"Distance matters: a population based study examining access to maternity services for rural women","volume":"11","author":"S Grzybowski","year":"2011","journal-title":"BMC health services research"},{"issue":"12","key":"pone.0306859.ref017","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1377\/hlthaff.2019.00910","article-title":"What is rural? Challenges and implications of definitions that inadequately encompass rural people and places","volume":"38","author":"KJ Bennett","year":"2019","journal-title":"Health Affairs"},{"issue":"12","key":"pone.0306859.ref018","doi-asserted-by":"crossref","first-page":"e036852","DOI":"10.1136\/bmjopen-2020-036852","article-title":"Impact of obstetric unit closures, travel time and distance to obstetric services on maternal and neonatal outcomes in high-income countries: a systematic review","volume":"10","author":"RS Malouf","year":"2020","journal-title":"BMJ open"},{"key":"pone.0306859.ref019","article-title":"Restoring access to maternity care in rural America. Transforming Care (newsletter)","author":"M Hostetter","year":"2021","journal-title":"Commonwealth Fund"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0306859","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T17:32:47Z","timestamp":1727976767000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0306859"}},"subtitle":[],"editor":[{"given":"Sheikh Irfan","family":"Ahmed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,10,3]]},"references-count":19,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0306859","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,3]]}}}