Geographic and socioeconomic disparities to retinopathy of prematurity treatment.

PURPOSE: To identify geographic and socioeconomic factors predictive of travel burden on families to neonatal intensive care units (NICUs) that provide acute treatment for retinopathy of prematurity (ROP) and long-term, outpatient follow up care.

DESIGN

This is a retrospective cross-sectional study.

METHODS

This cross-sectional analysis crosslinked data from a nationwide survey of NICU ROP treatment, with multiple large publicly available datasets. Geographic information systems analysis identified travel time from each census tract to the nearest NICU offering ROP treatment. Multivariable analysis identified socioeconomic predictors of driving time.

RESULTS

Rural residents had to travel significantly longer to reach an ROP treatment center compared to urban residents (103.23 ± 55.47 vs. 42.68 ± 41.40 min, p < 0.0001). Residents were more likely to travel > 60 min if they lived in rural census tracts (adjusted odds ratio [aOR] 1.33, 95% confidence interval [1.29-1.37], p < 0.0001) or lived in the West (aOR 1.11 [1.09-1.12], p < 0.0001) and South (aOR 1.19 [1.18-1.20], p < 0.0001), compared to the Northeast. Census tracts with a greater proportion living ≤ federal poverty level or with a greater proportion of non-whites also had increased travel burdens. In contrast, counties with higher percentages of births < 1500 g (aOR 0.90 [0.90-0.90], p < 0.0001) were less likely to travel > 60 min.

CONCLUSIONS

There are significant geographic access disparities to ROP treatment centers in the United States.