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Changing Landscape of Routine Pediatric Surgery for Rural and Urban Children: A Report From the Child Health
Samir K Gadepalli1, Harold J Leraas2, Katherine T Flynn-O'Brien3
1Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI.
Insights
Rural children, younger children, and those with Medicaid insurance traveled farther and were transferred more often for pediatric surgery over two decades. This highlights disparities in accessing routine surgical care.
Area of Science:
- Pediatric Surgery
- Healthcare Access
- Rural Health Disparities
Background:
- A knowledge gap exists regarding trends in pediatric surgical care location for urban versus rural children.
- Understanding these trends is crucial for addressing potential disparities in healthcare access.
Purpose of the Study:
- To describe changes in routine pediatric surgical care over two decades for children in urban and rural settings.
- To identify factors influencing travel distance and transfer status for pediatric surgical procedures.
Main Methods:
- Analysis of State Inpatient Databases (SID) from 2002-2017 for children (0-18) undergoing common surgeries.
- Classification of patients and hospitals using Rural-Urban Commuting Area codes.
- Multivariable regression models to compare travel distance (>60 miles) and transfer status between rural and urban populations, adjusting for covariates.
Main Results:
- Increased travel distance for care observed in both rural and urban children, with a significantly greater increase for the rural cohort (102% vs. 30%).
- Transfers also increased significantly for rural children, particularly for appendectomy (1% to 23%).
- Rural residence, younger age (<5 years), and Medicaid insurance were associated with increased travel distance and transfer status.
Conclusions:
- Rural children, younger children, and those insured by Medicaid disproportionately experienced longer travel distances and higher transfer rates for common pediatric surgical procedures.
- Findings indicate significant disparities in access to routine pediatric surgical care based on geographic location, age, and insurance status.
Objective:
To describe the changes to routine pediatric surgical care over the past 2 decades for children living in urban and rural environments.
Background:
A knowledge gaps exists regarding trends in the location where routine pediatric surgical care is provided to children from urban and rural environments over time.
Methods:
Children (age 0-18) undergoing 7 common surgeries were identified using State Inpatient Databases (SID, 2002-2017). Rural-Urban Commuting Area codes were used to classify patient and hospital zip codes. Multivariable regression models for distance traveled >60 miles and transfer status were used to compare rural and urban populations, adjusting for year, age, sex, race, and insurance status.
Results:
Among 143,467 children, 13% lived in rural zip codes. The distance traveled for care increased for both rural and urban children for all procedures but significantly more for the rural cohort (eg, 102% vs 30%, P <0.001, cholecystectomy). Transfers also increased for rural children (eg, transfers for appendectomy increased from 1% in 2002 to 23% in 2017, P <0.001). Factors associated with the need to travel >60 miles included year [adjusted odds ratio (aOR)=2.18, 95% CI: 1.94-2.46: 2017 vs 2002], rural residence (aOR=6.55, 95% CI: 6.11-7.01), age less than 5 years (aOR=2.17, 95% CI: 1.92-2.46), and Medicaid insurance (aOR=1.35, 95% CI: 1.26-1.45). Factors associated with transfer included year (aOR=5.77, 95% CI: 5.26-6.33: 2017 vs 2002), rural residence (aOR=1.47, 95% CI: 1.39-1.56), age less than 10 years (aOR=2.34, 95% CI: 2.15-2.54), and Medicaid insurance (aOR=1.49, 95% CI: 1.42-1.46).
Conclusion:
Rural children, younger age, and those on Medicaid disproportionately traveled greater distances and were more frequently transferred for common pediatric surgical procedures.
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