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Geospatial Access to Pediatric Cardiac and Cardiac-Surgical Services by Neighborhood-Level Determinants of Health
Julia K Weld1,2, R Thomas Day1,2, Faraz Alizadeh1,2
1Department of Cardiology Boston Children's Hospital Boston MA USA.
Background:
Access to quality health care is a key social determinant of health. We determined whether geographic access to pediatric cardiac services differed by neighborhood-level opportunity, racial and ethnic population composition, and urbanicity.
Methods:
Geospatial analysis delineated geographic access to hospitals with pediatric cardiac and cardiac-surgical services. Geographic access was defined in 4 drive-time catchments (0-30, 31-60, 61-120, and 121-240-minutes) and dichotomizing direct (≤60-minute) versus limited (>60-minute) access. Mean predicted Child Opportunity Index (COI), percentage of racial and ethnic populations considered medically underserved and rural-urban residence were compared by geographic access. Prevalence ratios compared the prevalence of limited geographic access for low COI and percentage of populations medically underserved catchments compared with high, and rural versus urban areas. Additional analyses controlled for hospital characteristics.
Results:
Limited access to pediatric cardiac and surgical care was more prevalent in very low quintile COI catchments versus very high (prevalence ratio, 3.64 [95% CI, 2.61-5.07] and 2.98 [95% CI, 2.04-4.35], respectively). Catchments with >60-minute drive time to cardiac care had on average>6 point lower COI. Catchments closer to cardiac services were more urban and with a higher percentage of populations medically underserved. Prevalence of limited geographic access to pediatric cardiac care was higher in rural versus urban catchments (prevalence ratio, 3.48 [3.02, 4.00]). Incorporating hospital characteristics increased COI differences and attenuated the higher percentage of populations medically underserved with direct cardiac-surgical access.
Conclusions:
On average, areas with fewer neighborhood-level resources promoting healthy child development are associated with greater distance to pediatric cardiac services. Geospatial analyses identify specific areas with limited access to cardiac care to focus future resource allocation.
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