title: Perinatal outcomes and travel time from home to hospital: Welsh data from 1995 to 2009.
abstract: OBJECTIVE
  To study the association between travel time from home to hospital and birth outcomes.
  
  
  METHODS
  For all registrable births to women resident in Wales (1995-2009), we calculated the travel time between the mother's residence and the postcode-based location for both the birth hospital and all hospitals with maternity services that were open. Using logistic regression, we obtained odds ratios for the association between travel time and each birth outcome, adjusted for confounders.
  
  
  RESULTS
  In our analysis of 412 827 singleton births, for every 15-min increase in travel time to the birth hospital, there was an increased risk of early (n = 609; OR: 1.13; 95%CI: 1.07, 1.20) and late neonatal death (n = 251; OR: 1.15; 95%CI: 1.05, 1.26). Results for intrapartum stillbirth were inconclusive (n = 135; OR: 1.13; 95%CI: 0.98, 1.30). For the above-combined (n = 995) results, we get OR: 1.15, 95%CI: 1.09, 1.20. No association was found with travel time to the nearest hospital (OR: 1.01; 95%CI: 0.90, 1.13 per 15-min increase in travel time) for the composite outcome of intrapartum stillbirth and neonatal deaths.
  
  
  CONCLUSIONS
  Longer travel time to the birth hospital was associated with increased risk of neonatal deaths, but there was no strong evidence of association with the geographical location of maternity services.
authors.affiliation: Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Shantini
authors.initials: S
authors.lastname: Paranjothy
authors.forename: W John
authors.initials: WJ
authors.lastname: Watkins
authors.forename: Kim
authors.initials: K
authors.lastname: Rolfe
authors.forename: Roshan
authors.initials: R
authors.lastname: Adappa
authors.forename: Yi
authors.initials: Y
authors.lastname: Gong
authors.forename: Frank
authors.initials: F
authors.lastname: Dunstan
authors.forename: Sailesh
authors.initials: S
authors.lastname: Kotecha
mesh_terms: D000328:Adult; D005260:Female; D006297:Health Services Accessibility; D006771:Hospitals, Maternity; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration; D008875:Middle Aged; D066087:Perinatal Death; D011247:Pregnancy; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology*; D013997:Time Factors; D014852:Wales / Q000453:epidemiology; D055815:Young Adult
keywords: neonatal mortality; perinatal mortality; prematurity; stillbirths; travel time