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Socioeconomic Disadvantage and Distance to Pediatric Critical Care
Lauren E Brown1,2, Urbano L França1,2, Michael L McManus1,2
1Division of Critical Care, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA.
Insights
The distance to pediatric critical care services increases with neighborhood poverty across the U.S. This disparity impacts access to care and health outcomes for children in underserved communities.
Area of Science:
- Public Health
- Pediatric Critical Care
- Health Services Research
Background:
- Geographic distribution of pediatric critical care services is not well-defined.
- Understanding the relationship between socioeconomic factors and access to specialized pediatric care is crucial for addressing health disparities.
Purpose of the Study:
- To map the geographic distribution of pediatric intensive care units (PICUs) in the United States.
- To examine the association between neighborhood poverty levels and the distance to the nearest PICU.
Main Methods:
- Retrospective, cross-sectional study utilizing data from the 2016 American Community Survey.
- Analysis of geographic concentration of PICUs and calculation of median distances from neighborhoods to PICUs based on the Area Deprivation Index.
Main Results:
- Pediatric critical care services are concentrated in urban areas, with significant geographic clustering.
- A clear positive correlation exists between neighborhood poverty (Area Deprivation Index) and increased distance to the nearest PICU.
- Children in the most impoverished neighborhoods face nearly triple the median travel distance to PICUs compared to those in the most affluent neighborhoods.
Conclusions:
- Significant disparities in proximity to pediatric critical care services exist, disproportionately affecting children in high-poverty areas.
- The findings highlight critical implications for equitable access to care and underscore the potential for exacerbating health outcome disparities.
Objectives:
To describe the geography of pediatric critical care services and the relationship between poverty and distance to these services across the United States.
Design:
Retrospective, cross-sectional study.
Setting:
Contiguous United States.
Patients:
Children less than 18 years as represented in the 2016 American Community Survey.
Interventions:
None.
Measurements And Main Results:
Pediatric critical care services were geographically concentrated within urban areas, with half of all PICUs located within 9.5 miles of another (interquartile range, 3.4-51.5 miles). Median distances from neighborhoods to the nearest unit increased linearly with Area Deprivation Index (p < 0.001), such that the median distance from the least privileged neighborhoods was nearly three times that of the most privileged neighborhoods (first decile = 7.8 miles [interquartile range, 3.4-15.8 miles] vs tenth decile = 22.6 miles [interquartile range, 4.2-52.5 miles]; p < 0.001). A relationship between neighborhood poverty and distance to a PICU was present across all U.S. regions and within urban/suburban and rural areas.
Conclusions:
In the United States, the distance to pediatric critical care services increases with poverty. This carries implications for access to care and health outcome disparities.
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