Academic pediatrics · 2025
Geospatial Accessibility of Pediatric Resources by Child Opportunity, Racial and Ethnic Composition and Urbanicity.
СтатьяПоддержка службы здравоохранения СШАНазвание и аннотация: Перевод в очереди
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Bucholz Emily M, Day R Thomas, Khazanchi Rohan, Alizadeh Faraz, Blossom Jeff, Bailey Dakota, Worthington Steven, Liu Jinjie, Thiagarajan Ravi, Ward Valerie L, Moynihan Katie M
Аннотация
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.
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.