【文献Abstract】郡部地域における産科ケアへのアクセスの影響

〈要点〉

・アラバマ州の郡部において、地域の分娩（L＆D）ユニットへのアクセスの有無よる死亡率の差の結果を調査。具体的には、L＆Dユニットがあるものとないものの2つのグループについて、乳児死亡率、周産期死亡率、新生児死亡率、低出生体重に基づいて比較を行った。

・乳児死亡率、周産期死亡率、新生児死亡率、低出生体重についてL＆Dユニットがある場合には良好な結果を示しており、郡部における産科ケアへのアクセスは、より良い乳児転帰と関連していることが示唆された。

〈雑感〉

・私自身も郡部の有床診療所にて数年間働いていたことがあったが、そこの診療所にも週1回で産婦人科医がきてくれていた。また、週1回以外の産婦人科専門外来がある日以外でも、家庭医・総合診療医が常勤で休日夜間含め対応していた。
・地域の子供を増やしていくためには安全な医療が提供される必要があり、そのためには産婦人科医が定期的にみる環境だけではなく、家庭医・総合診療医や地域の看護師を含めたケアスタッフによるケアユニットが必要なのだと改めて実感。

〈文献〉

Ann Fam Med. 2020 Sep;18(5):446-451. doi: 10.1370/afm.2580.
Effect of Access to Obstetrical Care in Rural Alabama on Perinatal, Neonatal, and Infant Outcomes: 2003-2017
John B Waits , Lacy Smith , Daniel Hurst 
PMID: 32928761 DOI: 10.1370/afm.2580

Abstract
Purpose: To evaluate differential mortality outcomes in rural Alabama counties with or without access to a local labor and delivery (L&D) unit.

Methods: This retrospective cohort study used county-level data from the Alabama Department of Public Health. Rural counties in Alabama were categorized into those with an L&D unit and those without. The 2 groups were compared based on infant mortality rate, perinatal mortality rate, neonatal mortality rate, and low birth weight.

Results: The infant mortality rate from 2003-2017 in the rural counties in Alabama with no local obstetrical care was 9.23 per 1,000 live births, whereas the infant mortality rate during the same period in the rural counties with continuous access to local obstetrical units was 7.89 (relative risk [RR] = 1.1679; 95% CI, 1.0643-1.2817, P = 0.0011). The percentage of low birth weight babies from the time period 2003-2014 in the rural counties in Alabama with no local obstetrical care was 10.61%, compared with 9.86% in the rural counties with continuous access to local L&D services (RR = 1.0756; 95% CI, 1.0424-1.1098, P <.0001). The perinatal mortality rate in counties with no active L&D was 10.82 per 1,000 still + live births compared with 8.89 in counties with an active L&D (RR = 1.2149; 95% CI, 1.1147-1.3242; P <.0001). The neonatal mortality rate during this period was 5.67 per 1,000 live births in counties with no active L&D, vs 4.74 in those counties with L&D services (RR = 1.1953; 95% CI, 1.0609-1.3466; P = 0.0034).

Conclusion: Access to local obstetrical care in a rural area is associated with better infant outcomes.

Keywords: health care quality, access, and evaluation; infant mortality; obstetrics; perinatal mortality; rural health.

© 2020 Annals of Family Medicine, Inc.