Cohort study uncovers lower birth volume and unprofitability as key drivers of obstetric care loss across US hospitals, suggesting high future vulnerability for maternity units.
Key Points
To evaluate hospital-level factors associated with obstetric care loss through obstetric unit or full hospital closures across rural and urban hospitals from 2010 to 2023.
Retrospective cohort study analyzing all US rural (n = 1126) and urban (n = 1982) hospitals providing obstetric services in 2010 using American Hospital Association and Centers for Medicare & Medicaid Services data through 2023.
Multinomial logistic regression evaluated outcomes (maintaining obstetric services, closing the unit, or closing entirely) against exposures including birth volume, distance to nearest obstetric hospital, nurse staffing, ownership, and unprofitability.
By 2023, 21.2% (239/1126) of rural hospitals closed their obstetric unit and 3.7% (42/1126) closed entirely, while 12.6% (250/1982) of urban hospitals closed their unit and 4.6% (92/1982) closed entirely.
Lowest birth volume quartiles had 31-pp (95% CI, 23.2-39.1 pp) higher predicted probabilities of unit closure, and unprofitability increased rural unit closure probability by 12 pp (95% CI, 6.8-17.5 pp).
Rural for-profit hospitals had 13-pp (95% CI, 2.8-22.2 pp) higher predicted probabilities of unit closure compared with government hospitals, and 41% of hospitals with active obstetric services in 2023 exhibited high-risk closure profiles.