Do rural and urban women experience differing rates of maternal rehospitalizations?
BACKGROUND
Conditions such as postpartum complications and mental disorders of new mothers contribute to a relatively large number of maternal rehospitalizations and even some deaths. Few studies have examined rural-urban differences in hospital readmissions, and none of them have addressed maternal readmissions. This research directly compares readmissions for patients who delivered in rural versus urban hospitals.


METHODS
The data for this cross-sectional study were drawn from the 2011 California Healthcare Cost and Utilization Project. Readmission rates were reported to demonstrate rural-urban differences. Generalized estimating equation models were also used to estimate the likelihood of a new mother being readmitted over time.


RESULTS
The 323 051 women who delivered with minor assistance and 158 851 women who delivered by cesarean section (C-section) were included in this study. Of those, seven maternal mortalities occurred after vaginal deliveries and 14 occurred after C-section procedures. Fewer than 1% (0.98% or 3171) women with normal deliveries were rehospitalized. The corresponding number for women delivering via C-section was 1.41% (2243). For both types of deliveries, women giving birth in a rural hospital were more likely to be readmitted.


CONCLUSIONS
This is the first study examining rural-urban differences in maternal readmissions. The results indicate the importance of monitoring and potentially improving the quality of maternal care, especially when the delivery involves a C-section. More studies investigating rural health disparities in women's health are clearly necessary.
Eliminate Health Disparities, Division of Health Policy and Legislative Affairs, University of Texas Medical Branch, Galveston, TX, USA . weilee@utmb.edu.
Wei-Chen
WC
Lee
Texas A&M Health Science Center, School of Public Health, College Station, TX, USA. phillipscd@sph.tamhsc.edu.
Charles D
CD
Phillips
Texas A&M Health Science Center, School of Public Health, Department of Health Policy and Management, College Station, TX, USA. rohsfeldt@sph.tamhsc.edu.
Robert L
RL
Ohsfeldt
D000328:Adult; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D007744:Obstetric Labor Complications / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011247:Pregnancy; D012111:Residence Characteristics; D012424:Rural Population / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*; D016387:Women's Health
Consumer perspectives; Determinants of Health; Health Service reform; Management/Administration; North America; Procedures; Public Health; Researcher; Women's Health