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Are new pediatric trauma centers located close to the high-risk populations? A geolocation study
Keyonna M Williams1, Nicole O Scholtz, Connor Plagens
1From the Section of Pediatric Surgery, Department of Surgery (K.M.W., C.P., D.T., P.F.E.), C.S. Mott Children's Hospital, Michigan Medicine, and Library Science Michigan Medicine (N.O.S.), University of Michigan, Arbor, Michigan.
Insights
Despite doubling pediatric trauma centers (PTCs), access for children in low-socioeconomic areas has not improved nationally. While 19 states show better access, the gap persists for high-risk children.
Area of Science:
- Public Health
- Pediatric Trauma Care
- Health Services Research
Background:
- Children in low socioeconomic areas experience higher injury rates.
- The number of verified Level I and Level II pediatric trauma centers (PTCs) has doubled since 2010.
- Geographic access to PTCs for vulnerable populations remains a critical concern.
Purpose of the Study:
- To analyze the geographic distribution of new verified PTCs.
- To assess the impact of new PTCs on access for children in high-risk, low-socioeconomic areas.
- To evaluate changes in 30-mile access to PTCs for children based on poverty levels from 2010 to 2020.
Main Methods:
- Retrospective cohort study using American College of Surgeons (ACS) and US Census Bureau data (2010, 2020).
- Geocoded PTC locations and pediatric population data (stratified by poverty and proximity to PTCs).
- Analyzed changes in 30-mile access to Level I/II PTCs for children below and above the poverty threshold.
Main Results:
- The number of verified PTCs increased from 55 (2010) to 116 (2020).
- In 2020, 52% of children below the poverty threshold lacked 30-mile access, compared to 45.54% above poverty.
- Improvement in 30-mile access was greater for children above the poverty level (24.8%) than below (22.6%).
Conclusions:
- Doubling the number of PTCs has not equitably improved 30-mile access for high-risk children nationally.
- Significant disparities in access persist between children below and above the poverty threshold.
- While 19 states improved access, national trends indicate a widening gap for vulnerable pediatric populations.
Background:
Higher rates of injury occur in children who live in low socioeconomic areas. Since 2010, the number of verified Level I and Level II pediatric trauma centers (PTCs) has doubled. The purpose of this study is to look at the location of new verified PTC in relation to children living in high-risk areas.
Methods:
Historical and recent data about verified Level I and Level II PTCs were obtained from the American College of Surgeons (ACS), the American Trauma Society, and State Data where available. Census data were obtained from the US Census Bureau's American Community Survey for 2010 and 2020 for children younger than 18 years. The pediatric population was stratified by (1) poverty threshold and (2) living within 30 miles of PTC. The census data and trauma center locations were geocoded using the ArcGIS Pro program. Data analysis was performed at the census tract level.
Results:
A total of 55 Level I or Level II ACS-verified PTCs were in the United States in 2010 and 116 in 2020. In 2010, there were 14.5 million children (19.6%) below the poverty threshold and 12.9 million (17.8%) in 2020. In 2010, 23 states did not have an ACS-verified PTC either in the state or in a neighboring state within 30 miles. By 2020, only nine states did not have an ACS-verified PTC or a center in a neighboring state within 30 miles. When state level data were included, this dropped to four. The 19 states who had new verified PTCs covered between 14% and 21% of children below the poverty level. The percentage of children below the poverty threshold and less than 30-mile access to a Level I or Level II PTC in 2010 was 74.56% compared with children above poverty and less than 30-mile access, which was 70.34% ( p < 0.0001). In 2020, children below poverty without 30-mile access had been reduced to 52% and 45.54% for children above poverty level ( p < 0.0001). Thus, there was a greater increase in 30-mile access for children above the poverty level than for those below the poverty level (24.8% vs. 22.6%, p < 0.001).
Conclusion:
On a national level, despite doubling the number of PTC, it has not improved 30-mile access for high-risk children. Alternatively, 19 states now have better access.
Level Of Evidence:
Prognostic and Epidemiological; Level IV.
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