Association of Maternity Care Deserts With Maternal and Pregnancy-Related Mortality.
Level 3 - non-randomized controlled study
Cross-sectional county-level observational study
PubMed 40570350 · doi:10.1097/AOG.0000000000005976
What was done
This was a cross-sectional study analyzing US county-level data from January 2018 to December 2021 covering 14,772,210 live births. Counties were categorized by maternity care access into desert (n=720,858), low access (n=708,668), moderate access (n=431,188), and full access (n=12,911,496). The primary outcome was maternal mortality rate per 100,000 live births, and the secondary outcome was pregnancy-related mortality rate per 100,000 live births. Absolute risk differences (ARD) and adjusted incidence rate ratios (aIRR) were estimated using multivariable negative binomial mixed-effects models.
What was found
Desert vs full-access counties: Maternal mortality rate was significantly higher (32.25 vs 23.62 per 100,000; ARD 8.62 [95% CI, 4.63-12.61]; aIRR 1.36 [95% CI, 1.21-1.54]), as was pregnancy-related mortality rate (43.82 vs 34.72 per 100,000; ARD 9.10 [95% CI, 4.28-13.93]; aIRR 1.26 [95% CI, 1.13-1.41]). Low-access counties showed no significant difference compared to full access in maternal mortality (24.04 vs 23.62; ARD 0.41 [95% CI, -3.68 to 4.51]; aIRR 1.02 [95% CI, 0.86-1.21]) or pregnancy-related mortality (35.63 vs 34.72; ARD 0.91 [95% CI, -4.06 to 5.88]; aIRR 1.03 [95% CI, 0.89-1.18]). Similarly, moderate-access counties showed no significant difference in maternal mortality (25.59 vs 23.62; ARD 1.96 [95% CI, -4.50 to 8.42]; aIRR 1.08 [95% CI, 0.84-1.40]) or pregnancy-related mortality (37.48 vs 34.72; ARD 2.76 [95% CI, -5.72 to 11.24]; aIRR 1.08 [95% CI, 0.86-1.36]).
Why it matters
This study provides large-scale national evidence showing that maternal and pregnancy-related mortality risks are significantly higher specifically in complete maternity care deserts, informing targeted resource allocation and policy interventions.
Limits
The study relies on county-level aggregate data rather than individual-level patient records, precluding adjustment for individual clinical risk factors or tracking patients who travel outside their county for care. Specific covariates adjusted for in the models and criteria defining access tiers are not detailed in the abstract.