Poster Session 3
Category: Health Equity/Community Health
Poster Session 3
Ruby Lin, MD
Maternal Fetal Medicine Physician
Kaiser Permanente Northern California
San Leandro, California, United States
Cande V. Ananth, PhD
Professor and Vice Chair for Academic Affairs, Department of Obstetrics, Gynecology, and Reproductive Sciences
Rutgers Robert Wood Johnson Medical School
Rutgers Robert Wood Johnson Medical School, New Jersey, United States
Todd J. Rosen, MD (he/him/his)
Professor of Obstetrics and Gynecology, Director of Maternal-Fetal Medicine
Jersey City Medical Center
Jersey City Medical Center, New Jersey, United States
Rachel Lee, MS
Rutgers Robert Wood Johnson Medical School
Rutgers Robert Wood Johnson Medical School, New Jersey, United States
With the recent focus on maternity care deserts, examining obstetric workforce density is extremely relevant. We hypothesized that a higher density of obstetrics and gynecology (OBGYN) physicians was associated with lower perinatal mortality.
Study Design:
Using the United States live birth, infant death, and fetal death data (2016 to 2020), this was a cross-sectional study of full-term, singleton, cephalic, and non-anomalous deliveries. County-level OBGYN physician density was estimated as the number of OBGYN physicians per 1,000 deliveries using the Area Health Resource Files and categorized into quintiles. Perinatal mortality included term stillbirth and neonatal death at ≤28 days. Confounder-adjusted relative risks (RR) were calculated using Poisson regression models with robust variance to assess the association between OBGYN density and perinatal mortality. Planned subgroup analyses were conducted to assess the association stratified by race/ethnicity, social vulnerability index, rural-urban county, county birth volume, and state abortion restrictions.
Results:
There were 16,094,208 full-term, singleton, cephalic, and non-anomalous deliveries. Perinatal mortality rates for quintiles 1 (lowest density) through 5 (highest density) were 2.4, 2.5, 2.3, 2.3, and 1.9 per 1000 births, respectively. Compared to quintile 5, the RR of perinatal mortality for quintiles 1 through 4 was 1.15 (95% CI 1.11-1.19), 1.19 (95% CI 1.16-1.23), 1.17 (95% CI 1.13-1.20), and 1.12 (95% CI 1.08-1.16), respectively (Figure). The highest quintile density was associated with the lowest risk of perinatal mortality regardless of determinants of health (Table). The exception was in counties with a high-risk social vulnerability index- increasing OBGYN density was not associated with decreasing perinatal mortality.
Conclusion:
Higher density of OBGYN physicians was associated with a lower risk of perinatal mortality, except in socially vulnerable counties. In addition to increasing access to obstetric care, this study underscores how social determinants shape perinatal mortality risks.