title: Individual and community predictors of preterm birth and low birthweight along the rural-urban continuum in central Pennsylvania.
abstract: BACKGROUND
  Preterm birth and low birthweight remain high priority public health problems and are associated with increased risk of infant mortality as well as long-term health impairments. Although 20% of all births nationally are to rural women, relatively little attention has been paid to pregnancy outcomes in rural areas relative to more urbanized areas.
  
  
  OBJECTIVE
  This study examines the relationship of individual- and community-level socioeconomic, health care, and health status-related characteristics to preterm birth and low birthweight outcomes among women living in urban and various types of rural communities.
  
  
  METHODS
  Vital record data on singleton first births to residents of a 28-county region in central Pennsylvania in 2002 (N = 11,546) were merged with zip code-level information from the census and residence in a primary care health professional shortage area. Rural-urban commuting area codes were also appended. Multiple logistic regression analyses were performed to model risks of preterm birth and low birthweight using generalized estimating equations to account for clustering within zip code.
  
  
  RESULTS
  Women residing in large rural city-focused areas had lower adjusted odds of both preterm birth and low birthweight as compared to urban women, controlling for individual risk factors including maternal demographic characteristics, health conditions, and prenatal care use. In contrast, risks of these adverse birth outcomes were not significantly lower among women living in more rural areas relative to those in urban communities.
  
  
  CONCLUSIONS
  Reduced risks of preterm birth and low birthweight risk are associated with some, but not all types of rural as compared to urban communities.
authors.affiliation: Department of Health Policy and Administration, Pennsylvania State University, University Park, PA 16802, USA. mmh18@psu.edu
authors.forename: Marianne M
authors.initials: MM
authors.lastname: Hillemeier
authors.forename: Carol S
authors.initials: CS
authors.lastname: Weisman
authors.forename: Gary A
authors.initials: GA
authors.lastname: Chase
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Dyer
mesh_terms: D000328:Adult; D001719:Birth Certificates; D002391:Catchment Area, Health; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016015:Logistic Models; D008427:Maternal Health Services / Q000458:organization & administration*; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D010414:Pennsylvania / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology* / Q000517:prevention & control; D012111:Residence Characteristics; D018570:Risk Assessment; D012423:Rural Health / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000458:organization & administration*; D012959:Socioeconomic Factors; D014504:Urban Health / Q000706:statistics & numerical data*; D016387:Women's Health