Geospatial Accessibility of Pediatric Resources by Child Opportunity, Racial and Ethnic Composition and Urbanicity

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics Pub Date : 2025-03-13 DOI:10.1016/j.acap.2025.102817

Emily M. Bucholz MD , R. Thomas Day Jr MD , Rohan Khazanchi MD MPH , Faraz Alizadeh MD , Jeff Blossom MA , Dakota Bailey MA , Steven Worthington PhD , Jinjie Liu PhD , Ravi Thiagarajan MBBS , Valerie L. Ward MD, MPH , Katie M. Moynihan MBBS

{"title":"Geospatial Accessibility of Pediatric Resources by Child Opportunity, Racial and Ethnic Composition and Urbanicity","authors":"Emily M. Bucholz MD , R. Thomas Day Jr MD , Rohan Khazanchi MD MPH , Faraz Alizadeh MD , Jeff Blossom MA , Dakota Bailey MA , Steven Worthington PhD , Jinjie Liu PhD , Ravi Thiagarajan MBBS , Valerie L. Ward MD, MPH , Katie M. Moynihan MBBS","doi":"10.1016/j.acap.2025.102817","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, <em>P</em>  <!-->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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 5","pages":"Article 102817"},"PeriodicalIF":3.0000,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Academic Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1876285925000427","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}

引用次数: 0

Abstract

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.

查看原文本刊更多论文

基于儿童机会、种族/民族构成和城市化的儿科资源地理空间可达性。

目的：我们根据儿童机会指数（COI）、种族/民族构成和城市化程度分析美国儿童住院和重症监护服务的开车时间。研究设计：地理空间信息系统分析划定了0-30分钟、31-60分钟、61-120分钟和120-240分钟车程的医院周围，医院有≥5个儿科和儿科重症监护病房（PICU）床位。对于每个集水区，计算人口加权COI、未被充分代表的种族/民族儿科人口百分比（%UR）和城市化程度，并在四个驾驶时间集水区之间以及驾驶时间为60分钟与≤60分钟的集水区之间进行比较。计算了60分钟与≤60分钟驾驶时间的患病率（PR），以比较COI较低和UR %较低（与较高）的集水区以及农村与城市地区较长的驾驶时间的患病率。结果：总体而言，8.1%和20.5%的儿童在儿科和PICU服务中心居住60分钟。与60分钟的住院或PICU服务相比，60分钟内的集水区COI更高（分别为4.8,[95%CI 3.2, 6.5]和6.1[7.7,4.5]）。非常低的五分位数COI集水区（相对于非常高的）更有可能在距儿科住院护理60分钟（PR为2.89[2.30,3.61]）和PICU （PR为2.48[1.92,3.20]）。%UR在60分钟内提高了2.7%。在UR %较低（相对较高）的集水区以及儿科和PICU服务的农村（相对城市）集水区，bbbb60分钟驾驶时间的患病率更高。结论：远离儿科护理的儿童往往资源较少，居住在农村地区。这些数据为公共卫生解决方案提供信息，以便在保健巩固时公平分配资源。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Academic Pediatrics PEDIATRICS-

CiteScore

4.60

自引率

12.90%

发文量

300

审稿时长

60 days

期刊介绍： Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.