Date of Award

Spring 3-8-2023

Embargo Period

3-27-2023

Document Type

Dissertation

Degree Name

Doctor of Health Administration

Department

Health Administration

College

College of Health Professions

First Advisor

Mary Dooley

Second Advisor

Dunc Williams, Jr.

Third Advisor

Rita Gordon

Abstract

The closure of rural hospitals and obstetric units have disproportionally impacted expectant mothers on Medicaid, increased travel distances, and accessibility to adequate prenatal care. These closures are affecting communities of color and low-income communities at greater rates than other communities, contributing to access to care barriers. Literature shows lack of rural obstetric access contributes to rural women having higher rates of cesarean sections. This is specifically impactful to North Carolina, one of the top 10 most rural states in the nation.

Using North Carolina HCUP hospital admissions data for 2017, a retrospective cohort analysis was conducted to determine outcomes of Black mothers and infants compared to white mothers and infants in rural and nonrural zip codes. Using this data, cesarian sections and complications during childbirth were assessed for mothers while and mortality complications within the first year of life were examine for infants. Models were assessed using multivariable logistic regression.

Results found confirmed disparities related to infant mortality (OR=2.4), higher odds of delivering via cesarian section for Black mothers vs white mothers in rural zip codes (OR=1.08), and increased odds of experiencing complications for black mothers compared to white mothers (OR=1.11).

Rights

Copyright is held by the author. All rights reserved.

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