Assessment of healthcare accessibility and travel distance on intrapartum fetal death: a retrospective cohort study
Objective. To determine if there was an association between intrapartum stillbirths and both traveled distance for delivery and delivery care accessibility, assessing periods before and during the COVID-19 pandemic. Methods. This is a population-based cohort study. Patients had birth occurring after...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Pan American Health Organization
2023-12-01
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| Series: | Revista Panamericana de Salud Pública |
| Subjects: | |
| Online Access: | https://iris.paho.org/handle/10665.2/58696 |
| _version_ | 1827269545116565504 |
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| author | Vinicius Cesar Moterani Joelcio Francisco Abbade Vera Therezinha Medeiros Borges Cecilia Guimarães Ferreira Fonseca Nathalia Desiderio Nino Jose Wilson Moterani Junior Laura Bresciani Bento Gonçalves Moterani |
| author_facet | Vinicius Cesar Moterani Joelcio Francisco Abbade Vera Therezinha Medeiros Borges Cecilia Guimarães Ferreira Fonseca Nathalia Desiderio Nino Jose Wilson Moterani Junior Laura Bresciani Bento Gonçalves Moterani |
| author_sort | Vinicius Cesar Moterani |
| collection | DOAJ |
| description | Objective. To determine if there was an association between intrapartum stillbirths and both traveled distance for delivery and delivery care accessibility, assessing periods before and during the COVID-19 pandemic.
Methods. This is a population-based cohort study. Patients had birth occurring after the onset of labor; the primary outcome was intrapartum stillbirth. City of residence was classified according to the ratio between deliveries performed and total births among its residents; values lower than 0.1 indicated low delivery care accessibility. Travel distance was calculated using the Haversine formula. Education level, maternal age, and birth sex were included. In each period, relative risk was assessed by generalized linear model with Poisson variance.
Results. There were 2 267 534 deliveries with birth occurring after the onset of labor. Most patients were between age 20 and 35 years, had between 8 and 11 years of education, and resided in cities with high delivery care accessibility. Low delivery care accessibility increased risk of intrapartum stillbirth in the pre-pandemic (relative risk [RR] 2.02; 95% CI [1.64, 2.47]; p < 0.01) and the pandemic period (RR 1.69; 95% CI [1.09, 2.55]; p = 0.015). This was independent of other risk-increasing factors, such as travel distance and fewer years of education.
Conclusions. Low delivery care accessibility is associated with the risk of intrapartum stillbirths, and accessibility reduced during the pandemic. Delivery of patients by family physicians and midwives, as well as official communication channels between primary care physicians and specialists, could improve patient healthcare-seeking behavior. |
| first_indexed | 2024-03-09T00:56:01Z |
| format | Article |
| id | doaj.art-caa5b1dc977848c7a39156d072a91747 |
| institution | Directory Open Access Journal |
| issn | 1020-4989 1680-5348 |
| language | English |
| last_indexed | 2025-03-22T05:07:14Z |
| publishDate | 2023-12-01 |
| publisher | Pan American Health Organization |
| record_format | Article |
| series | Revista Panamericana de Salud Pública |
| spelling | doaj.art-caa5b1dc977848c7a39156d072a917472024-04-27T10:09:43ZengPan American Health OrganizationRevista Panamericana de Salud Pública1020-49891680-53482023-12-014714911010.26633/RPSP.2023.149rpspAssessment of healthcare accessibility and travel distance on intrapartum fetal death: a retrospective cohort studyVinicius Cesar Moterani0Joelcio Francisco Abbade1Vera Therezinha Medeiros Borges2Cecilia Guimarães Ferreira Fonseca3Nathalia Desiderio4Nino Jose Wilson Moterani Junior5Laura Bresciani Bento Gonçalves Moterani6Universidade Estadual Paulista “Júlio de Mesquita Filho,” Botucatu, BrazilUniversidade Estadual Paulista “Júlio de Mesquita Filho,” Botucatu, BrazilUniversidade Estadual Paulista “Júlio de Mesquita Filho,” Botucatu, BrazilUniversidade Estadual Paulista “Júlio de Mesquita Filho,” Botucatu, BrazilMarilia Medical School, Marilia, BrazilMarilia Medical School, Marilia, BrazilMarilia Medical School, Marilia, BrazilObjective. To determine if there was an association between intrapartum stillbirths and both traveled distance for delivery and delivery care accessibility, assessing periods before and during the COVID-19 pandemic. Methods. This is a population-based cohort study. Patients had birth occurring after the onset of labor; the primary outcome was intrapartum stillbirth. City of residence was classified according to the ratio between deliveries performed and total births among its residents; values lower than 0.1 indicated low delivery care accessibility. Travel distance was calculated using the Haversine formula. Education level, maternal age, and birth sex were included. In each period, relative risk was assessed by generalized linear model with Poisson variance. Results. There were 2 267 534 deliveries with birth occurring after the onset of labor. Most patients were between age 20 and 35 years, had between 8 and 11 years of education, and resided in cities with high delivery care accessibility. Low delivery care accessibility increased risk of intrapartum stillbirth in the pre-pandemic (relative risk [RR] 2.02; 95% CI [1.64, 2.47]; p < 0.01) and the pandemic period (RR 1.69; 95% CI [1.09, 2.55]; p = 0.015). This was independent of other risk-increasing factors, such as travel distance and fewer years of education. Conclusions. Low delivery care accessibility is associated with the risk of intrapartum stillbirths, and accessibility reduced during the pandemic. Delivery of patients by family physicians and midwives, as well as official communication channels between primary care physicians and specialists, could improve patient healthcare-seeking behavior.https://iris.paho.org/handle/10665.2/58696travelhealth services accessibilitytime-to-treatmentfetal mortalitybrazil |
| spellingShingle | Vinicius Cesar Moterani Joelcio Francisco Abbade Vera Therezinha Medeiros Borges Cecilia Guimarães Ferreira Fonseca Nathalia Desiderio Nino Jose Wilson Moterani Junior Laura Bresciani Bento Gonçalves Moterani Assessment of healthcare accessibility and travel distance on intrapartum fetal death: a retrospective cohort study Revista Panamericana de Salud Pública travel health services accessibility time-to-treatment fetal mortality brazil |
| title | Assessment of healthcare accessibility and travel distance on intrapartum fetal death: a retrospective cohort study |
| title_full | Assessment of healthcare accessibility and travel distance on intrapartum fetal death: a retrospective cohort study |
| title_fullStr | Assessment of healthcare accessibility and travel distance on intrapartum fetal death: a retrospective cohort study |
| title_full_unstemmed | Assessment of healthcare accessibility and travel distance on intrapartum fetal death: a retrospective cohort study |
| title_short | Assessment of healthcare accessibility and travel distance on intrapartum fetal death: a retrospective cohort study |
| title_sort | assessment of healthcare accessibility and travel distance on intrapartum fetal death a retrospective cohort study |
| topic | travel health services accessibility time-to-treatment fetal mortality brazil |
| url | https://iris.paho.org/handle/10665.2/58696 |
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