United States Rural Residence Is Associated With Increased Acute Maternal End-organ Injury or Mortality After Birth: A Retrospective Multistate Analysis, 2007-2018

( Int J Obstet Anesth . 2023;56:103916. doi:10.1016/j.ijoa.2023.103916) The maternal mortality rate in the USA rose from 7.2 to 23.8 deaths per 100,000 live births between 1987 and 2020. This increase, along with a 200% rise in severe maternal morbidity (SMM), may be partly due to increased comorbidity among expectant mothers. However, social determinants of health also play a role, including location, race/ethnicity, and age. Analysis of national data shows that women in highly urban or rural areas face higher risks of combined SMM and mortality compared with those in smaller cities. Anesthetic choice further influences outcomes, with neuraxial analgesia linked to lower SMM rates during vaginal births. Access to such anesthesia may vary based on social determinants like rural-urban disparities. This study aims to explore differences in maternal outcomes based on residency, anesthesia type, and mode of delivery, hypothesizing that rural residents face more significant risks and disparities in anesthesia access.