Too far to care? A cohort study on travel distance and hospital use in children living with respiratory support.

AIM: Children aged 0-18 years living with respiratory support represent a growing population worldwide. They have complex medical needs and rely on multidisciplinary care. Transportation is often challenging, and paediatric respiratory support teams are concentrated in a limited number of hospitals. As of 2024, Swedish paediatric long-term respiratory care facilities (PRCF) are centralised at four centres. We aimed to explore the relationship between travel distance from home to PRCF, healthcare utilisation and mortality before centralisation.

METHODS

A retrospective, population-based cohort study using data from the Swedish Quality Registry for Respiratory Failure (Swedevox) between 2015 and 2021. Multivariable linear regression models and survival analyses were applied to examine the associations between travel distance, healthcare utilisation and mortality.

RESULTS

A total of 596 children were included (mean age 5.4±5.1 years). Of these, 76% lived within 60 min of a PRCF (median 19 km, IQR 8-34), while 24% had travel times exceeding 60 min (median 171 km, IQR 105-268). No association was found between travel time to PRCF and healthcare utilisation or death before age 19. Children whose parents had 12+ years of education underwent more hospitalisations annually (R 0.29, 95% CI 0.01 to 0.57), and children in rural areas had fewer emergency visits (R -0.47, 95% CI 0.84 to -0.10).

CONCLUSIONS

No associations were found between travel distance and healthcare utilisation or mortality among children with long-term respiratory support. Centralised PRCF may thus be feasible without compromising outcomes, but reforms should recognise possible unintended effects on children and families.