(916) Social determinants of health, barriers to obstetrical care, and their impact on preterm birth

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: To evaluate the impact of barriers to obstetrical care from the Social Determinants of Health (SDoH) framework on preterm birth (PTB) rates in a predominantly rural, underserved demographic.

Study Design: We conducted a retrospective cohort study of pregnancies delivering at an academic safety net hospital from July 2018 to June 2021. The primary study exposure was defined as any barrier to obstetrical care, using the SDoH framework. Patient sociodemographic and obstetrical characteristics were abstracted from electronic medical records and compared between people with and without PTB. The Kaplan-Meier method was used to calculate the probability of a term pregnancy. The extended Cox Proportional Hazards Model was used to estimate the effect of barriers to obstetrical care on the probability of giving birth at term while adjusting for relevant confounding variables. Stepwise, backward, and best subset logistic regression methods were used to determine the final model.

Results: Of the 6576 patients included in the study, 1352 experienced PTB (20.6%). Barriers to care were reported more frequently among women who experienced a PTB as compared to those without (69.45% vs. 8.76%, p< .001). Several demographic and clinical characteristics differed significantly among women with and without PTB including rates of clinical therapy for vaginal progesterone, cervical length surveillance and cerclage placement. Unadjusted survival curves evaluating the presence and absence of barriers to care were significantly different (unadjusted HR = 1.89, 95% CI = 1.46 – 2.43, p< .001) After adjusting and stratifying for relevant covariates, women with barriers to care had a significantly higher PTB rate, as compared to those without barriers (aHR = 1.33, 95% CI 1.04 – 1.66, p = 0.017).

Conclusion:

Barriers to obstetrical care in the context of the SDoH framework have a significant impact on PTB rates despite increased rates of utilization of clinical interventions directed at PTB prevention. This underscores the need for continued emphasis on social determinants to mitigate the risk for PTB.

Primary Author(s)

Christopher Smith, MD
Physician
SpringView Hospital
Atlanta, Georgia, United States

Presenting Author(s)

Zachary D. Stanley, MD (he/him/his)
Fellow Physician
Saint Louis University/St. Mary's SSM Heatlh
St. Louis, Missouri, United States

Coauthor(s)

NC
Niraj R. Chavan, MD, MPH
Saint Louis University School of Medicine
St. Louis, Missouri, United States