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Geospatial Accessibility of Pediatric Resources by Child Opportunity, Racial and Ethnic Composition and Urbanicity
Emily M Bucholz1, R Thomas Day2, Rohan Khazanchi3
1Department of Pediatrics (EM Bucholz), University of Colorado Anschutz, Aurora, Colo; Section of Cardiology (EM Bucholz), Children's Hospital Colorado, Aurora, Colo.
Insights
Children living further from pediatric care often have fewer resources and live in rural areas. This highlights disparities in access to essential healthcare services for vulnerable populations.
Area of Science:
- Pediatric healthcare access and disparities
- Geospatial health analysis
- Public health policy
Background:
- Access to pediatric inpatient and intensive care services is crucial for child health outcomes.
- Existing research suggests geographic and socioeconomic factors influence healthcare access.
- Consolidation of care may exacerbate existing access challenges.
Purpose of the Study:
- To analyze drive times to pediatric inpatient and intensive care units (PICUs) in the US.
- To assess how drive times correlate with the Child Opportunity Index (COI), racial/ethnic composition, and urbanicity.
- To identify disparities in access to pediatric critical care services.
Main Methods:
- Geospatial analysis to delineate drive-time catchments around hospitals with pediatric and PICU beds.
- Calculation of population-weighted COI, percentage of underrepresented racial/ethnic populations (%UR), and urbanicity for each catchment.
- Comparison of drive times (>60 vs. ≤60 minutes) based on COI, %UR, and urbanicity using prevalence ratios.
Main Results:
- 8.1% of children live >60 minutes from pediatric inpatient services, and 20.5% live >60 minutes from PICU services.
- Children in lower COI areas and rural areas are more likely to experience longer drive times to these services.
- %UR was higher in catchments within 60 minutes of care, suggesting underserved populations face longer travel distances.
Conclusions:
- Children residing further from pediatric care often have fewer socioeconomic resources and live in rural areas.
- These findings underscore significant disparities in access to critical pediatric healthcare services.
- Data can inform public health strategies for equitable distribution of resources during healthcare consolidation.
Objective:
We analyze drive times to pediatric inpatient and intensive care services in the US according to Child Opportunity Index (COI), racial/ethnic composition, and urbanicity.
Methods:
Geospatial information system analyses delineated drive-time catchments of 0-30, 31-60, 61-120 and 120-240 minutes around hospitals with ≥5 inpatient pediatric and pediatric intensive care unit (PICU) beds. For each catchment, population-weighted COI, percent pediatric population of underrepresented races and ethnicities (%UR), and urbanicity were calculated and compared between the four drive-time catchments and for >60 versus ≤60-minute drive-times. Prevalence ratios (PR) were calculated for >60 versus ≤60-minute drive-times to compare the prevalence of longer drive-times for catchments with lower COI and lower %UR (vs higher), and rural versus urban areas.
Results:
Overall, 8.1% and 20.5% of children reside >60-minutes from pediatric and PICU services. Catchments within 60-minutes of inpatient or PICU services had higher COI (4.8, [95% CI 3.2, 6.5] and 6.1 [7.7, 4.5] respectively) compared with those >60-minutes. Very low quintile COI catchments (vs very high) were more likely to be >60-minutes from pediatric inpatient care (PR 2.89 [2.30, 3.61]) and PICU (PR 2.48 [1.92, 3.20]). %UR was 2.7% higher in ≤60-minute drive-time catchments (95% CI 0.1, 5.23, P=0.043) versus those >60-minutes. Greater prevalence of >60-minute drive-times was seen in catchments with a lower %UR (vs higher) and for rural (vs urban) catchments for pediatric and PICU services.
Conclusions:
Children living further from pediatric care tend to have less resources and reside in rural areas. These data inform public health solutions for equitable resource distribution as care consolidates.
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