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Disparities in geographic access to pediatric subspecialty care
1Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA. michelle_mayer@unc.edu
Insights
Children in poverty and those in rural areas face longer travel distances to pediatric subspecialty care. Geographic access is limited in the Mountain and West North Central regions.
Area of Science:
- Health Services Research
- Pediatric Subspecialty Care Access
- Geographic Health Disparities
Background:
- Geographic access to pediatric subspecialty care is crucial for timely diagnosis and treatment.
- Understanding factors influencing access can help address healthcare disparities.
Purpose of the Study:
- To identify correlates of geographic access to pediatric medical subspecialists in the U.S.
- To determine characteristics of populations at risk for poor geographic access.
Main Methods:
- Calculated straight-line distance from zip code centroids to nearest pediatric subspecialist for all U.S. zip codes.
- Utilized data from the American Board of Pediatrics and Claritas' Pop-Facts Database.
- Employed 16 specialty-specific random-effects multiple regression models to analyze zip code characteristics.
Main Results:
- Shorter distances to care were associated with younger populations, metropolitan status, and proximity to teaching facilities.
- Higher poverty concentrations correlated with increased distances to pediatric subspecialists.
- Zip codes in the Mountain and West North Central regions showed significantly greater distances.
Conclusions:
- Populations at risk for poor geographic access include those in high-poverty zip codes, rural/small metropolitan areas, and specific U.S. regions.
- The study highlights geographic barriers to pediatric subspecialty care, particularly for vulnerable populations.
- Further research is needed to establish the impact of these distances on care receipt.
Purpose:
To identify correlates of geographic access to pediatric medical subspecialists in the United States and identify characteristics of populations at risk for poor geographic access.
Methods:
Geographic access was operationalized as distance to care. Using data from the American Board of Pediatrics and the Claritas' Pop-Facts Database, the straight-line distance between each zip code in the United States and the nearest subspecialist was calculated for each pediatric subspecialty using zip code centroids. Using 16 specialty-specific, random-effects multiple regression models, zip code characteristics associated with being farther from a subspecialty provider were identified.
Results:
Under-18 population, metropolitan status, and presence of a nearby teaching facility were associated with shorter distances to care across pediatric subspecialties. The proportion of the population below the federal poverty level was positively associated with greater distances to care. Zip codes in the Mountain and West North Central regions, likewise, were significantly farther from pediatric subspecialists, even when statistically controlling for other factors.
Conclusions:
Pediatric populations at risk for poor geographic access to pediatric subspecialty care include those who reside in zip codes with high concentrations of poverty, in rural and small metropolitan areas, and in the Mountain and West North Central regions. The extent to which these distances create barriers to receipt of care is not established.
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