Rural–urban disparities in pregestational and gestational diabetes in pregnancy: Serial, cross‐sectional analysis of over 12 million pregnancies

Abstract

ObjectiveTo compare trends in pregestational (DM) and gestational diabetes (GDM) in pregnancy in rural and urban areas in the USA, because pregnant women living in rural areas face unique challenges that contribute to rural–urban disparities in adverse pregnancy outcomes.DesignSerial, cross‐sectional analysis.SettingUS National Center for Health Statistics (NCHS) Natality Files from 2011 to 2019.PopulationA total of 12 401 888 singleton live births to nulliparous women aged 15–44 years.MethodsWe calculated the frequency (95% confidence interval [CI]) per 1000 live births, the mean annual percentage change (APC), and unadjusted and age‐adjusted rate ratios (aRR) of DM and GDM in rural compared with urban maternal residence (reference) per the NCHS Urban–Rural Classification Scheme overall, and by delivery year, reported race and ethnicity, and US region (effect measure modification).Main outcome measuresThe outcomes (modelled separately) were diagnoses of DM and GDM.ResultsFrom 2011 to 2019, there were increases in both the frequency (per 1000 live births; mean APC, 95% CI per year) of DM and GDM in rural areas (DM: 7.6 to 10.4 per 1000 live births; APC 2.8%, 95% CI 2.2%–3.4%; and GDM: 41.4 to 58.7 per 1000 live births; APC 3.1%, 95% CI 2.6%–3.6%) and urban areas (DM: 6.1 to 8.4 per 1000 live births; APC 3.3%, 95% CI 2.2%–4.4%; and GDM: 40.8 to 61.2 per 1000 live births; APC 3.9%, 95% CI 3.3%–4.6%). Individuals living in rural areas were at higher risk of DM (aRR 1.48, 95% CI 1.45%–1.51%) and GDM versus those in urban areas (aRR 1.17, 95% CI 1.16%–1.18%). The increased risk was similar each year for DM (interaction p = 0.8), but widened over time for GDM (interaction p < 0.01). The rural–urban disparity for DM was wider for individuals who identified as Hispanic race/ethnicity and in the South and West (interaction p < 0.01 for all); and for GDM the rural–urban disparity was generally wider for similar factors (i.e. Hispanic race/ethnicity, and in the South; interaction p < 0.05 for all).ConclusionsThe frequency of DM and GDM increased in both rural and urban areas of the USA from 2011 to 2019 among nulliparous pregnant women. Significant rural–urban disparities existed for DM and GDM, and increased over time for GDM. These rural–urban disparities were generally worse among those of Hispanic race/ethnicity and in women who lived in the South. These findings have implications for delivering equitable diabetes care in pregnancy in rural US communities.

Special Supplemental Nutrition Program for Women, Infants, and Children Enrollment and Adverse Pregnancy Outcomes Among Nulliparous Individuals

“…However, these exploratory analyses may be limited by the smaller sample size of the strata. Pregnant individuals in rural areas are more likely to have comorbid medical conditions and adverse pregnancy outcomes 44,45 and to experience a higher burden of unmet social needs. 46 Further efforts to improve uptake of WIC services in rural communities may be needed.…”

Maternal and Child Healthcare Services in Aceh Province, Indonesia: A Correlation and Clustering Analysis in Statistics

“…Many factors influence the birth rate, including age at first marriage, family planning program, education level, and employment status [25,26]. The birth rate, also known as natality, is the frequency of live births in a population, which is obtained from the number of live births per thousand population each year [27]. Birth rate is a measure that shows the population growth in a country [28].…”