Child Opportunity Index Levels and Disparities in Access to Pediatric-ready Emergency Departments

Increased pediatric readiness has been shown to decrease pediatric mortality, although disparities in access to pediatric-ready emergency departments (ED) have not been studied. The Child Opportunity Index (COI) is a comprehensive measure of the quality of neighborhood resources impacting child health and development. Our objective was to determine whether low-resourced areas with low COI levels are associated with farther travel distances to the nearest pediatric-ready ED.

In this retrospective, cross-sectional study we evaluated the 2021 National Pediatric Readiness Project (NPRP) assessments of 91 EDs throughout the state of Missouri in relationship to COI 3.0 U.S. census tract data. The EDs were classified into quartiles based on weighted pediatric readiness scores (wPRS). Our primary outcome measure was travel distances to the nearest ED, which were obtained by measuring the shortest distance from the geographic center of each U.S. census tract to the closest ED. We used the Kruskal-Wallis H test to assess distances from the geographic center of each census tract to the nearest EDs. P values were adjusted for multiple comparisons using Dunn-Bonferroni post hoc tests.

Of the 113 EDs in Missouri that were invited to take the 2021 NPRP assessment, 91 (81%) participated and 22 (19%) were nonrespondent. Child Opportunity Index data were available for all 1,393 Missouri U.S. census tracts. When compared to low-resourced, low COI census tracts, well-resourced, very high COI census tracts were found to have significantly shorter travel distances to the nearest ED (6 vs 2.9 miles, [95% CI, 3.03-3.6; P < .001]). Families living in low COI census tracts travel 4.6 times farther (18 additional miles) to reach an ED in the highest wPRS quartile compared to families living in very high COI census tracts (23.3 vs 5.1 miles, [95% CI, 5.6-6.5; P < .001]). Families living in low COI census tracts travel 4.4 times farther (48 additional miles) to reach the nearest of the top three most pediatric-ready EDs [62.6 vs 14.4 miles, [95% CI, 14.6-19.1; P < .001].

Families from resource-limited communities with low Child Opportunity Index levels must travel significantly farther to access pediatric-ready EDs compared to families from well-resourced communities. Dissemination of pediatric-readiness improvement efforts, especially to under-resourced areas, may help address disparities in healthcare access and promote health equity.