Rural residency as a risk factor for severe maternal morbidity

Anna C. Hansen, Svetla Slavova, John M. O'Brien

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Purpose: The goal of this study was to evaluate how rural/urban status and other risk factors alter women's odds of severe maternal morbidity (SMM) at delivery. Methods: This study used 48,608 Kentucky resident delivery hospitalization records from 2017. We used multiple logistic regression with interaction terms to evaluate the moderating effect of rural/urban residence with other risk factors. We reported adjusted odds ratios (aORs) and 95% confidence intervals (CIs) as measures for association with the outcome of SMM at delivery. Findings: The percentage of delivery hospitalizations with SMM was higher for women with rural (2.4%) versus metro (1.1%) or metro-adjacent (1.5%) residence (p <.001). Rural status moderated the effect of anemia on SMM. The aOR for SMM for women with anemia versus those without was 8.56 (CI: 4.89–14.97) in rural areas, two times higher than in metro areas (aOR 3.87; CI: 3.09–4.86). Kentucky Appalachian region (aOR 1.90; CI: 1.46–2.47), Black race (aOR 1.30; CI: 1.02–1.66), history of cesarean section (aOR 1.28; CI: 1.07–1.52), hypertension (aOR 10.55; CI: 5.67–19.62), and opioid use (aOR 1.72; CI: 1.19–2.47) were significantly associated with SMM. Conclusion: Rural women in Kentucky are at an increased risk for SMM. Quality and safety programming should specifically address the needs of isolated subpopulations. Women living in rural areas are more likely to experience SMM given an anemia diagnosis. The underlying cause and clinical management of anemia may differ between rural and urban areas.

Original languageEnglish
Pages (from-to)161-170
Number of pages10
JournalJournal of Rural Health
Issue number1
StatePublished - Jan 1 2022

Bibliographical note

Funding Information:
This project was supported by Grant No. 2017-PM-BX-K026, Data-Driven Responses to Prescription Drug Misuse in Kentucky, awarded by the Bureau of Justice Assistance (BJA) to the Kentucky Injury Prevention and Research Center as bona fide agent for the Kentucky Department for Public Health. The BJA is a component of the Department of Justice's Office of Justice Programs, which include the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office of Victims Crime, and the SMART Office. Viewpoints or opinions in this document are those of the authors and do not necessarily represent the official position or policies of the U.S. Department of Justice. The authors would like to thank Josh Bush, PhD, for his support of this manuscript.

Publisher Copyright:
© 2021 National Rural Health Association

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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