361 - Rural and Urban Health Disparities in Preterm Children Aged 5-17 in British Columbia, Canada

Publication Number: 361.6422

Lindsay Richter, University of British Columbia, Vancouver, BC, Canada; YE SHEN, BC Children's Hospital Research Institute, Richmond, BC, Canada; Jeffrey N.. Bone, BC Children's Hosiptal Research Institute, Vancouver, BC, Canada; sarka Lisonkova, UBC, Vancouver, BC, Canada; Joseph Ting, University of Alberta, Edmonton, AB, Canada

Background: Health disparities exist between urban and rural communities, with higher rates of preterm birth and severe neonatal morbidity in rural areas. Our previous research showed that rural children had more hospitalization and fewer outpatient visits by age five than urban children. Few population-based studies have examined preterm health outcomes by geographical area in late childhood (ages 5-9) and adolescent (ages 10-17) health outcomes among those born preterm by geographical area.

Objective: To compare health service use, morbidity, and medication use among children aged 5-17 years in rural versus urban residences.

Design/Methods: The study included liveborn infants at 22-44 weeks’ gestational age (GA) in British Columbia (BC), Canada, 2004-2014. Follow-up data to 2019 included linked health information from four provincial databases (perinatal database, outpatient visits, hospitalizations, and outpatient prescriptions) extracted by Population Data BC. Urban-rural status was based on maternal residence at birth. Rate ratios (RR) of health service use, childhood morbidity and medication use were compared within GA categories (22-27, 28-33, 34-36, 37-44) by rural vs. urban region using Poisson regression.

Results: There were 88,600 (11.1%) rural and 710,095 (88.9%) urban children included in this study. 67,660 children were born at < 37 weeks GA, and the preterm birth rate was 8.5%. Compared to urban areas, children in rural regions had more hospitalizations and fewer outpatient visits throughout late childhood (Table 1) and persisting through adolescence to age 17 (Table 2). Rural children born at 34-36 weeks had lower rates of asthma in late childhood (RR: 0.81, 95% CI: 0.73-0.89) compared to urban children. They were prescribed more antibiotics (RR: 1.04, 95% CI: 1.01-1.06) and less steroids (RR: 0.80, 95% CI: 0.77-0.83).

Conclusion(s): Preterm children living in rural BC experience higher hospitalization rates and fewer outpatient visits compared to their urban counterparts, with disparities persisting through adolescence. These findings in health status and service use suggest a need for improved healthcare access and targeted resources for rural preterm children as they grow.

TABLE 1. Health service use, morbidity, and medications among preterm children in rural versus urban communities by gestational age category in late childhood (5-9 years old)
†RR: Rate ratio for rural/urban; CI: Confidence interval; IQR: interquartile range
*Morbidity means any diagnosis of a specific condition.
**Growth and development include growth failure (short stature), growth excess (tall stature), precocious puberty and disorder of sexual development (ambiguoius genitalia, micropenis).

TABLE 2. Health service use, morbidity, and medications among preterm children in rural versus urban communities by gestational age category in adolescence (10-17 years old)
†RR: Rate ratio for rural/urban; CI: Confidence interval; IQR: interquartile range
*Morbidity means any diagnosis of a specific condition.
**Growth and development include growth failure (short stature), growth excess (tall stature), precocious puberty and disorder of sexual development (ambiguoius genitalia, micropenis).