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Rural Disparities in Early Childhood Well Child Visit Attendance
Pamela B DeGuzman1, Guoping Huang2, Genevieve Lyons3
1University of Virginia School of Nursing, VA, United States of America.
Insights
Rural children attend fewer well child visits (WCVs), delaying developmental disorder identification. Different rurality metrics impact WCV access findings, with insurance type also playing a role.
Area of Science:
- Pediatric Health Outcomes
- Rural Health Disparities
- Developmental Screening Access
Background:
- Well child visits (WCVs) are crucial for early developmental disorder identification and intervention in young children.
- Understanding factors influencing WCV access, such as geographic location, is essential for equitable healthcare.
- Previous research has not fully explored how different measures of rurality affect WCV attendance.
Purpose of the Study:
- To determine if rurality impacts access to well child visits (WCVs) during early childhood.
- To investigate whether altering rurality measurement methods influences the observed impact on WCV access.
- To identify disparities in WCV attendance based on geographic location and insurance type.
Main Methods:
- Longitudinal correlational design using early childhood claims data from Virginia (n=6349).
- Evaluation of WCV attendance against three rurality metrics: Rural-Urban Commuting Area codes, developed land percentage, and distance to care.
- Analysis of data at the zip code level.
Main Results:
- Two rurality metrics indicated rural children attend fewer WCVs than urban children (67% vs. 50% by traditional metric).
- Increased developed land correlated with higher WCV attendance (0.035 increase per percent).
- Children with Medicaid had lower WCV attendance compared to those with private insurance.
Conclusions:
- Rural young children face reduced access to WCVs, increasing risk for missed developmental disorder screenings.
- The COVID-19 pandemic likely exacerbated WCV and vaccination rate declines, further impacting developmental screenings.
- Pediatric nurses should promote WCV planning to ensure timely developmental disorder identification.
Purpose:
Children should attend well child visits (WCVs) during early childhood so that developmental disorders may be identified as early as possible, so treatment can begin. The aim of this research was to determine if rurality impacts access to WCV during early childhood, and if altering rurality measurement methods impacts outcomes.
Design And Methods:
We utilized a longitudinal correlational design with early childhood data gathered from the Virginia All Payer Claims Database, which contains claims data from Medicaid and the majority of Virginia commercial insurance payers (n = 6349). WCV attendance was evaluated against three rurality metrics: a traditional metric using Rural-Urban Commuting Area codes, a developed land variable, and a distance to care variable, at a zip code level.
Results:
Two of the rurality methods revealed that rural children attend fewer WCVs than their urban counterparts, (67% vs. 50% respectively, using a traditional metric; and a 0.035 increase in WCV attendance for every percent increase in developed land). Differences were attenuated by insurance payer; children with Medicaid attend fewer WCVs than those with private insurance.
Conclusions:
Young children in rural Virginia attend fewer WCVs than their non-rural counterparts, placing them at higher risk for missing timely developmental disorder screenings. The coronavirus disease pandemic has been associated with an abrupt and significant reduction in vaccination rates, which likely indicates fewer WCVs and concomitant developmental screenings. Pediatric nurses should encourage families of young children to develop a plan for continued WCVs, so that early identification of developmental disorders can be achieved.
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