IS NON-METROPOLITAN RESIDENCE A RISK FACTOR FOR POOR BIRTH OUTCOME INTHE US

The association between non-metropolitan residence and the risk of poo r birth outcome in the United Stares was examined using the records of 11.06 million singleton births in the United States between 1985 and 1987. Rates of neonatal and post-neonatal death, low birth weight and late prenatal care among non-metropolitan residents were compared to t he rates among metropolitan residents. The association between residen ce in a non-metropolitan area and the risk of poor birth outcome was a ssessed in national and state level regression analyses. Residence in a non-metropolitan county was not found to be associated with increase d risk of low birth weight or neonatal mortality at the national level or in most states, after controlling for several demographic and biol ogical risk factors. Non-metropolitan residence was associated with gr eater risk of post-neonatal mortality at the national level. Nonmetrop olitan residence was strongly associated with late initiation of prena tal care at both the national level and in a majority of the states. R esidence in non-metropolitan areas does not appear to be associated wi th higher risk of adverse birth outcome. Regionalization of perinatal care and other changes in the rural health care system may have mitiga ted the risk associated with residing in areas relatively isolated fro m tertiary care. High levels of late prenatal care among non-metropoli tan residents suggest a continuing problem of access to routine care f or rural women and their infants that may be associated with higher le vels of post-neonatal mortality and childhood morbidity. (C) 1997 Else vier Science Ltd.