The regionalization of rural perinatal care during the 1980's significantly lowered neonatal mortality among infants born to rural residents, yet recent trends could disrupt the efficiency of regionalized systems of care. This study is determining whether there is evidence of deregionalization of rural perinatal care for high-risk women and infants and whether deregionalization has adversely affected neonatal mortality among infants born to rural residents. The main source of data is the NCHS National Linked Birth Death Data Set (LBDDS) data for the years 1985-87 and 1995-97. The study population includes all low birthweight infants born to rural residents of the United States. In a regionalized system of perinatal care, a high proportion of low birth weight infants will be delivered in tertiary settings. We are examining trends in the concentration of deliveries of high-risk infants born to rural residents in urban counties to assess whether perinatal care systems deregionalized.

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