J Korean Med Sci.  2022 Mar;37(10):e77. 10.3346/jkms.2022.37.e77.

Perinatal Outcomes According to Accessibility to Maternal-Fetal and Neonatal Intensive Care Units by Region in Korea

• Lee JH
• Kwon HS
• Noh YM
• Shin H
• Kim T
• Lee TH
• Chang YS

• KMID: 2526982
• DOI: http://doi.org/10.3346/jkms.2022.37.e77

Abstract

Background
Herein, we aimed to evaluate the maternal mortality ratio and perinatal mortality rate for different perinatal medical care service areas (PMCSAs), which were established by considering their geographical accessibility to maternal-fetal intensive care units (MFICUs) and neonatal intensive care units (NICUs), and to compare the PMCSAs according to their accessibility to these perinatal care services.
Methods
Based on the 70 hospital service areas (HSAs) across the country confirmed through the Dartmouth Atlas methodology analysis and gathering of expert opinions, the PMCSAs were designated by merging HSAs without MFICUs and NICUs to the nearest HSA that contained MFICUs and NICUs, based on which MFICU and NICU could be reached within the shortest amount of time from population-weighted centroids in HSAs. PMCSAs where 30% or more of the population could not access MFICUs and NICUs within 60 minutes were identified using the service module ArcGIS and were defined as having access vulnerability.
Results
Thirty-three of 70 HSAs in the country did not contain MFICUs and NICUs, and 39 PMCSAs were finally derived by merging 70 HSAs. Ten of 39 PMCSAs (25.6%) were classified as having access vulnerability to MFICUs and NICUs. The national maternal mortality ratio was 9.42, with the highest ratio seen in the region of Wonju (25.86) and the lowest in Goyang (2.79). The national perinatal mortality rate was 2.86, with the highest and lowest rates observed in the Gunsan (4.04) and Sejong (1.99) regions, respectively. The perinatal mortality rates for areas vulnerable and invulnerable to maternal and neonatal healthcare accessibility were 2.97 and 2.92, respectively, but there was no statistically significant difference in this rate (P = 0.789). The maternal mortality ratio for areas vulnerable and invulnerable to maternal and neonatal healthcare accessibility were 14.28 and 9.48, respectively; this ratio was significantly higher in areas vulnerable to accessibility (P = 0.022).
Conclusion
Of the PMCSAs across the country, 25.6% (10/39) were deemed to be vulnerable to MFICU and NICU accessibility. There was no difference in the perinatal mortality rate between the vulnerable and invulnerable areas, but the maternal mortality ratio in vulnerable areas was significantly higher than that in invulnerable areas.

Keyword

Maternal Mortality; Perinatal Mortality; Health Service Accessibility; Intensive Care Unit; Neonatal

Figure

• 

  Fig. 1 Establishment of PMCSAs analyzed using the ArcGIS closet facility. (A) Current status of the candidate regional perinatal centers with maternal-fetal intensive care units and neonatal intensive care units. (B) Identification of regions without candidate institutions. (C) Analysis to identify the optimization path to candidate institutions in adjacent region. (D) Establishment of PMCSAs.PMCSA = perinatal medical care service area.

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  Fig. 2 Formulation of PMCSAs. (A) Composition of PMCSAs through optimization path. (B) Thirty-nine newly formulated PMCSAs.PMCSA = perinatal medical care service area.

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  Fig. 3 Areas with access vulnerability to NICUs. (A) distribution of hospitals with NICUs. (B) Areas with NICU services. (C) Arrival time to NICU by region. (D) Areas with access vulnerability to NICUs.NICU = neonatal intensive care unit.

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  Fig. 4 Areas with access vulnerability to MFICU. (A) distribution of hospitals with MFICUs. (B) Areas with MFICU services. (C) Arrival time to MFICU by region. (D) Areas with access vulnerability to MFICU.MFICU = maternal-fetal intensive care unit.

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  Fig. 5 Perinatal mortality rates and maternal mortality ratio in 39 perinatal medical care service areas. (A) Perinatal mortality rates. (B) Maternal mortality ratio.

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