Median driving distance to hospital: 11.3 (IQR, 5.4 to 21.6) km
Overall rate of composite maternal outcome: 0.6%
Overall rate of NICU admission: 8.4%
Compared with the referent distance, increasing driving distance was significantly associated with increased risks for
Maternal composite outcome
For 60 km: aRR 1.22 (95% CI, 1.07 to 1.36)
For 70 km: aRR 1.36 (95% CI, 1.19 to 1.53)
For 80 km: aRR 1.53 (95% CI, 1.31 to 1.75)
For 60 km: aRR 1.70 (95% CI, 1.65 to 1.76)
For 70 km: aRR 1.96 (95% CI, 1.90 to 2.02)
For 80 km: aRR 2.25 (95% CI, 2.18 to 2.33)
Threshold for increased risks
Maternal Composite Outcome: Statistically significant increased risk began at 60 km
Newborn (NICU admission): Statistically significant risk began at 5 km
A long driving distance (60 to 80 km) to delivery hospital was associated with a greater risk of adverse maternal outcomes and NICU admission
The authors state
We found that the shortest distances to the delivery hospital do not ensure the lowest risk of adverse outcomes, which may indicate an influence of social deprivation in urban centers where labor and delivery hospitals are commonly located
Yet, significantly increasing risks as driving distance increased may reflect a direct consequence of health care delivery deficits
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