Individual and Community Predictors of Preterm Birth and Low Birthweight along the Rural-Urban Continuum in Central Pennsylvania

Context: Preterm birth and low birthweight remain high priority public health problems and are associated with increased risk of infant mortality as well as long-term health impairments. Although 20% of all births nationally are to rural women, relatively little attention has been paid to pregnancy outcomes in rural areas relative to more urbanized areas. Purpose: This study examines the relationship of individual- and community-level socioeconomic, health care, and health status-related characteristics to preterm birth and low birthweight outcomes among women living in urban and various types of rural communities. Methods: Vital record data on singleton first births to residents of a 28-county region in central Pennsylvania in 2002 (N = 11,546) were merged with zip code-level information from the census and residence in a primary care health professional shortage area. Rural-urban commuting area codes were also appended. Multiple logistic regression analyses were performed to model risks of preterm birth and low birthweight using generalized estimating equations to account for clustering within zip code. Findings: Women residing in large rural city-focused areas had lower adjusted odds of both preterm birth and low birthweight as compared to urban women, controlling for individual risk factors including maternal demographic characteristics, health conditions, and prenatal care use. In contrast, risks of these adverse birth outcomes were not significantly lower among women living in more rural areas relative to those in urban communities. Conclusions: Reduced risks of preterm birth and low birthweight risk are associated with some, but not all types of rural as compared to urban communities.