Table 2:
Factors Associated with Odds of Bypassing the Nearest Hospital to give birth at a farther hospital-based obstetric unit
| Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | |
|---|---|---|---|---|---|
| Lives on Reservation | 2.322* (2.084,2.586) | 2.139** (1.885,2.427) | 2.562* (2.269,2.892) | 0.904 (0.802,1.019) | 10.63* (3.268,34.57) |
| Race (White ref) | |||||
| Black | 0.674* (0.459,0.992) | 0.670* (0.456,0.985) | 0.672* (0.457,0.989) | 1.072 (0.698,1.645) | 1.030 (0.667,1.590) |
| AI/AN | 0.763* (0.680,0.856) | 0.784* (0.698,0.881) | 0.765* (0.682,0.858) | 0.670* (0.590,0.760) | 0.591* (0.515,0.678) |
| Asian | 0.641* (0.481,0.854) | 0.641* (0.481,0855) | 0.639* (0.480,0.852) | 0.918 (0.672,1.254) | 0.934 (0.682,1.278) |
| Hispanic | 0.573* (0.489,0.671) | 0.573* (0.489,0.672) | 0.574* (0.489,0.672) | 0.764* (0.644,0.907) | 0.766* (0.644,0.910) |
| Age (in years) | 1.010* (1.004,1.016) | 1.010* (1.004,1.016) | 1.010* (1.004,1.016) | 1.015* (1.008,1.021) | 1.015* (1.008,1.021) |
| Education (college plus ref) | |||||
| Less than High School education | 1.545* (1.378,1.732) | 1.550* (1.383,1.738) | 1.545* (1.378,1.733) | 1.192* (1.054,1.347) | 1.179* (1.042,1.334) |
| High school | 1.329* (1.219,1.449) | 1.323* (1.214,1.443) | 1.331* (1.221,1.451) | 1.173* (1.068,1.289) | 1.182* (1.075,1.299) |
| Some college | 1.306* (1.210,1.410) | 1.302* (1.206,1.406) | 1.308* (1.212,1.412) | 1.121* (1.031,1.219) | 1.134* (1.042,1.233) |
| Had pregnancy risk factor(s) | 1.140* (1.066,1.218) | 1.138* (1.065,1.216) | 1.186* (1.106,1.272) | 1.181* (1.099,1.269) | 1.189* (1.106,1.279) |
| Birth was preterm | 1.543* (1.388,1.717) | 1.538* (1.382,1.711) | 1.543* (1.387,1.716) | 1.746* (1.552,1.963) | 1.764* (1.567,1.987) |
| Birth was low birth weight | 1.282* (1.144,1.438) | 1.282* (1.143,1.438) | 1.284* (1.145,1.439) | 1.505* (1.326,1.709) | 1.512* (1.330,1.719) |
| Cesarean section | 1.086* (1.018,1.158) | 1.085* (1.018,1.157) | 1.089* (1.021,1.161) | 1.060 (0.988,1.136) | 1.040 (0.969,1.116) |
| Attending provider type (Doctor ref) | |||||
| Midwife | 0.612* (0.546,0.687) | 0.613* (0.547,0.688) | 0.613* (0.547,0.687) | 0.789* (0.698,0.892) | 0.690* (0.609,0.782) |
| Other provider | 1.333 (0.984,1.807) | 1.351 (0.997,1.832) | 1.334 (0.984,1.808) | 0.497* (0.364,0.679) | 0.521* (0.381,0.713) |
| Had a previous live birth | 1.032 (0.970,1.099) | 1.031 (0.968,1.097) | 1.032 (0.970,1.099) | 0.950 (0.887,1.017) | 0.956 (0.893,1.024) |
| Birth was to multiples | 1.499* (1.305,1.722) | 1.510* (1.315,1.735) | 1.491* (1.298,1.713) | 1.596* (1.363,1.868) | 1.545* (1.318,1.811) |
| Kotelchuck Prenatal Care index (adequate plus ref) | |||||
| No prenatal care | 0.929 (0.685,1.259) | 0.960 (0.708,1.302) | 0.926 (0.683,1.255) | 0.811 (0.588,1.119) | 0.661* (0.476,0.917) |
| Inadequate care | 1.610* (1.479,1.753) | 1.611* (1.479,1.755) | 1.612* (1.480,1.755) | 1.415* (1.289,1.554) | 1.398* (1.273,1.537) |
| Intermediate care | 1.760* (1.588,1.950) | 1.758* (1.586,1.948) | 1.762* (1.590,1.953) | 1.594* (1.423,1.786) | 1.569* (1.399,1.761) |
| Adequate care | 1.286* (1.201,1.376) | 1.285* (1.200,1.376) | 1.289* (1.204,1.380) | 1.166* (1.082,1.256) | 1.148* (1.065,1.238) |
| Insurance (self-pay ref) | |||||
| Private insurance | 0.759* (0.661,0.871) | 0.737* (0.642,0.846) | 0.759* (0.661,0.872) | 0.784* (0.672,0.916) | 0.779* (0.666,0.911) |
| Medicaid | 0.597* (0.520,0.685) | 0.597* (0.520,0.685) | 0.598* (0.520,0.685) | 0.625* (0.535,0.730) | 0.627* (0.536,0.733) |
| Military insurance | 0.270* (0.196,0.371) | 0.267* (0.195,0.368) | 0.271* (0.197,0.373) | 1.132 (0.785,1.632) | 1.099 (0.760,1.588) |
| Indian Health Services (IHS) | 0.260* (0.196,0.346) | 1.709* (1.095,2.699) | 0.262* (0.197,0.348) | 0.224* (0.167,0.300) | 0.146* (0.108,0.197) |
| Reservation X Insurance | |||||
| Lives on reservation X Private Insurance | 1.543* (1.267,1.878) | ||||
| Lives on reservation X IHS | 0.100* (0.059,0.170) | ||||
| Lives on Reservation X Pregnancy risk | 0.752* (0.636,0.889) | ||||
| Rurality Urban Continuum Codes (RUCC; RUCC 3 ref) | |||||
| 5 | 12.10* (9.938,14.72) | 12.38* (10.15,15.10) | |||
| 6 | 46.25* (37.71,56.74) | 65.75* (53.32,81.09) | |||
| 7 | 84.19* (69.46,102.0) | 72.93* (59.97,88.70) | |||
| 8 | 47.76* (38.50,59.25) | 46.56** (37.39,57.98) | |||
| 9 | 118.60** (97.16,144.7) | 142.90* (116.7,175.0) | |||
| Reservation X RUCC | |||||
| Lives on reservation X RUCC 5 | 0.177* (0.043,0.738) | ||||
| Lives on reservation X RUCC 6 | 0.035* (0.011,0.114) | ||||
| Lives on reservation X RUCC 7 | 0.230* (0.070,0.755) | ||||
| Lives on reservation X RUCC 8 | 0.238* (0.067,0.853) | ||||
| Lives on reservation X RUCC 9 | 0.025* (0.007,0.084) | ||||
| Constant | 0.076* (0.060,0.096) | 0.077* (0.061,0.097) | 0.074* (0.058,0.093) | 0.004* (0.002,0.005) | 0.004* (0.003,0.005) |
| Pseudo R2 | 0.031 | 0.033 | 0.031 | 0.238 | 0.250 |
| BIC | 36797.7 | 36734.7 | 36797.4 | 29056.3 | 28634.1 |
Notes: coefficients are odds ratios; 95% confidence intervals are in parentheses; n = 54,146 births to individuals who were residents of Montana at the time of birth, who gave birth at a hospital facility
*
p < .05
RUCC codes described in measurement section