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Rural-Urban Disparities in Mortality Among US-Born Preterm Infants
Stephanie L Bourque1, Kathleen E Hannan1, Sara C Handley2
1Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado.
Hospital Pediatrics
|May 12, 2025
Summary
Rural preterm infants face higher infant mortality rates compared to urban infants. These disparities are influenced by race and ethnicity, highlighting the need for targeted interventions.
Area of Science:
- Public Health
- Neonatal Research
- Rural Health Disparities
Background:
- US infant mortality rate (IMR) is higher in rural areas.
- Existing research lacks data disaggregated by preterm birth status.
- Preterm birth significantly increases infant mortality risk.
Purpose of the Study:
- To evaluate rural-urban differences in infant mortality among preterm infants.
- To determine the prevalence and predictors of infant mortality by race/ethnicity and residence.
- To identify specific disparities in preterm infant mortality.
Main Methods:
- Utilized linked national birth and death certificate data (2005-2014).
- Categorized residence as rural or urban using 2013 Urban Influence Codes.
- Employed multivariable logistic regression to analyze associations between IMR, residence, race, and ethnicity.
Main Results:
- Among over 4 million preterm births, 3.23% resulted in infant death.
- Rural preterm infants had a 9% higher odds of mortality compared to urban infants (aOR, 1.09).
- Rural non-Hispanic white and American Indian/Alaska Native preterm infants showed increased mortality odds compared to urban non-Hispanic white infants.
Conclusions:
- Preterm infants in rural areas experience higher infant mortality, with variations by race and ethnicity.
- Data underscore the critical need for interventions to reduce mortality in rural preterm populations.
- Addressing rural-urban and racial/ethnic disparities is crucial for improving infant survival rates.
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