The social determinants of health-Rurality and pregnancy

This paper examines the distribution of social determinants of health (SDoH) among pregnant individuals, comparing urban and rural populations, with a sub-analysis of variations within the rural population.

Demographic and SDoH screening data were analyzed from electronic medical records within a large, integrated health system. The sample included 6510 individuals who delivered within the health system over a 1-year study period. Statistical tests were conducted to determine differences in demographic and SDoH factors at the time of delivery between urban and rural groups (binary classification) and within the rural group (three-level classification).

Rural pregnant individuals were younger, Whiter, and publicly insured more than urban pregnant individuals (all p values < 0.0001). A total of 4.4% of urban individuals experienced one adverse SDoH compared to 5.8% of rural individuals (p = 0.03). Small-town pregnant individuals were less White, more Hispanic, and more publicly insured and uninsured than large-town and isolated-town individuals. Large-town (10.4%, p = 0.002) and small-town (11.9%, p = 0.0003) pregnant individuals experienced increased rates of at least one adverse SDoH compared to isolated-town (7.5%) pregnant individuals. Differences were present among rural pregnant individuals in housing, food, and transportation domains.

Demographic and SDoH differences persist between urban and rural pregnant individuals. However, differences are also present within the rural population, noting the heterogeneity of rural areas which must not be overlooked. To understand the amplitude of SDoH experiences and effectively develop interventions to address adverse SDoH, detailed rural groupings must be considered.