The urban-remote divide for Indigenous perinatal outcomes.
OBJECTIVE
To determine whether remoteness category of residence of Indigenous women affects the perinatal outcomes of their newborn infants.


METHODS
A population-based study of 35 240 mothers identified as Indigenous and their 35 658 babies included in the National Perinatal Data Collection in 2001-2004.


METHODS
Australian Standard Geographical Classification remoteness category, birthweight, Apgar score at 5 minutes, stillbirth, gestational age and a constructed measure of perinatal outcomes of babies called "healthy baby" (live birth, singleton, 37-41 completed weeks' gestation, 2500-4499 g birthweight, and an Apgar score at 5 minutes >or= 7).


RESULTS
The proportion of healthy babies in remote, regional and city areas was 74.9%, 77.7% and 77.6%, respectively. After adjusting for age, parity, smoking and diabetes or hypertension, babies born to mothers in remote areas were less likely to satisfy the study criteria of being a healthy baby (adjusted odds ratio [AOR], 0.87; 95% CI, 0.81-0.93) compared with those born in cities. Babies born to mothers living in remote areas had higher odds of being of low birthweight (AOR, 1.09; 95% CI, 1.01-1.19) and being born with an Apgar score < 7 at 5 minutes (AOR, 1.63; 95% CI, 1.39-1.92).


CONCLUSIONS
Only three in four babies born to Indigenous mothers fell into the "healthy baby" category, and those born in more remote areas were particularly disadvantaged. These findings demonstrate the continuing need for urgent and concerted action to address the persistent perinatal inequity in the Indigenous population.
Graham
Simon
S
National Centre for Epidemiology and Population Health, College of Medicine and Health Sciences, Australian National University, Canberra, ACT, Australia.
Pulver
Lisa R Jackson
LR
Wang
Yueping Alex
YA
Kelly
Paul M
PM
Laws
Paula J
PJ
Grayson
Narelle
N
Sullivan
Elizabeth A
EA
D000328:Adult; D001315:Australia / Q000453:epidemiology; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007229:Infant Welfare / Q000706:statistics & numerical data; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D008429:Maternal Welfare / Q000706:statistics & numerical data; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology*; D011295:Prenatal Care / Q000458:organization & administration; D012424:Rural Population / Q000706:statistics & numerical data*; D012931:Social Environment; D014505:Urban Population / Q000706:statistics & numerical data*