Supplemental Table 1: Unadjusted Odds Ratios (AOR) of Differences by Rural Status, Annual Time Trends, and Differential
Time Trends by Rural for Obstetric Procedures, N=7,188,972
AOR [95% CI] a
Nb
Cesarean delivery among low risk women
Vaginal birth after cesarean (VBAC)
Labor induction without medical indication
Cesarean delivery without medical indication
5,244,898
1,061,184
4,014,572
5,384,872
Rural (vs. urban)
1.00 [0.98-1.01]
0.64 [0.62-0.67]
0.97 [0.95-0.98]
1.01 [0.99-1.02]
Time trend
1.04 [1.03-1.04]
0.91 [0.9-0.91]
1.02 [1.02-1.02]
1.02 [1.02-1.03]
Differential annual
time trend for rural
(vs. urban)
0.99 [0.99-1.00]
0.96 [0.95-0.97]
1.05 [1.05-1.06]
0.99 [0.99-1.00]
Note: All models use standard errors adjusted for hospital clustering.
Bold type indicates statistical significance at P<.05.
a. 95% CI- 95% Confidence Interval.
b. N-total hospitalizations among women eligible to experience the outcome (i.e. low risk women, women with prior cesarean deliveries; women without medical indications for induction or cesarean).
Supplemental Table 2: Adjusted Odds Ratios (AOR) of Differences by Rural Status, Annual Time Trends, and Differential
Time Trends by Rural for Obstetric Procedures, N=7,188,972
AOR [95% CI] a
Nb
Cesarean delivery among low risk women
Vaginal birth after cesarean (VBAC)
Labor induction without medical indication
Cesarean delivery without medical indication
5,244,898
1,061,184
4,014,572
5,384,872
Rural (vs. urban)
1.02 [1.01-1.03]
0.64 [0.61-0.66]
0.97 [0.95-0.98]
1.00 [0.99-1.02]
Time trend
1.04 [1.03-1.04]
0.91 [0.90-0.91]
1.02 [1.02-1.02]
1.03 [1.02-1.03]
Differential annual
time trend for rural
(vs. urban)
0.99 [0.99-1.00]
0.96 [0.95-0.97]
1.05 [1.05-1.06]
0.99 [0.99-1.00]
Note: All models use standard errors adjusted for hospital clustering and control for age only.
Bold type indicates statistical significance at P<.05.
a. 95% CI- 95% Confidence Interval.
b. N-total total hospitalizations among women eligible to experience the outcome (i.e. low risk women, women with prior cesarean deliveries; women without medical indications for induction or
cesarean).
Supplemental Table 3: Adjusted Odds Ratios (AOR) of Differences by Rural Status, Annual Time Trends, and Differential
Time Trends by Rural for Obstetric Procedures, N=7,188,972
AOR [95% CI] a
Nb
Cesarean delivery among low risk women
Vaginal birth after cesarean (VBAC)
Labor induction without medical indication
Cesarean delivery without medical indication
5,244,898
1,061,184
4,014,572
5,384,872
Rural (vs. urban)
1.03 [1.02-1.05]
0.64 [0.62-0.67]
0.85 [0.84-0.87]
1.00 [0.99-1.02]
Time trend
1.04 [1.03-1.04]
0.91 [0.90-0.91]
1.03 [1.03-1.03]
1.03 [1.02-1.03]
Differential annual
time trend for rural
(vs. urban)
0.99 [0.99-1.00]
0.96 [0.95-0.97]
1.05 [1.05-1.05]
0.99 [0.99-1.00]
Note: All models use standard errors adjusted for hospital clustering and control for age and race/ethnicity only.
Bold type indicates statistical significance at P<.05.
a. 95% CI- 95% Confidence Interval.
b. N- total hospitalizations among women eligible to experience the outcome (i.e. low risk women, women with prior cesarean deliveries; women without medical indications for induction or cesarean).
Supplemental Table 4: Adjusted Odds Ratios (AOR) of Differences by Rural Status, Annual Time Trends, and Differential
Time Trends by Rural for Obstetric Procedures, N=7,188,972
AOR [95% CI] a
Ne
Cesarean delivery among low risk women c
Vaginal birth after cesarean (VBAC) d
Labor induction without medical indication
Cesarean delivery without medical indication e
5,244,898
1,061,184
4,014,572
5,384,872
Rural (vs. urban)
1.02 [1.01-1.04]
0.64 [0.62-0.67]
0.79 [0.78-0.81]
1.03 [1.01-1.04]
Time trend
1.04 [1.04-1.04]
0.91 [0.90-0.91]
1.04 [1.04-1.04]
1.03 [1.03-1.03]
Differential annual
time trend for rural
(vs. urban)
0.99 [0.99-0.99]
0.96 [0.95-0.97]
1.05 [1.05-1.06]
0.99 [0.99-0.99]
Note: All models use standard errors adjusted for hospital clustering and control for age, race/ethnicity, primary payer types and the following corresponding clinical conditions.
Bold type indicates statistical significance at P<.05.
a. 95% CI- 95% Confidence Interval.
b. N- total hospitalizations among women eligible to experience the outcome (i.e. low risk women, women with prior cesarean deliveries; women without medical indications for induction or cesarean).
c. Additional clinical covariates: diabetes, hypertension, post-term pregnancy, fetal disproportion, fetal distress, placental complications (placenta previa, placenta accreta).
d. Additional clinical covariates: diabetes, hypertension, post-term pregnancy, fetal disproportion, preterm delivery, multiple gestation, fetal distress, placental conditions (placenta previa, placenta
accrete).
e. Additional clinical covariates: diabetes, hypertension, post-term pregnancy, fetal disproportion, fetal distress.