Illustrating the role of infant well child visits in the association between transportation insecurity and acute healthcare use.

Abstract

Objective: To evaluate the role of well-child visits (WCVs) in mediating associations between transportation insecurity and acute healthcare usage among infants.

Methods: This was a retrospective cohort study of 4,114 infants seen for newborn visits at three primary care centers between February 1, 2019 and March 31, 2021. Each infant was followed through 15 months of age. The outcome of interest was acute healthcare usage, defined by high-acuity emergency department (ED) visit or hospitalization. The exposure was transportation insecurity as reported by parents through standardized questionnaires administered during WCVs. We stratified analyses by WCV attendance (≥6 WCVs vs. <6 WCVs in first 15 months of life) to assess whether WCVs mediated associations between acute healthcare usage and transportation insecurity.

Results: Of 4,114 eligible infants, 8.7% endorsed transportation insecurity. Patients reporting transportation insecurity, compared to those who did not, had higher rates of incomplete WCV attendance (60.3% vs. 44.2%, p<0.001), ED visitation (38.0% vs. 28.7%; p<0.001), and hospitalization (19.8% vs. 14.1%; p=0.004). Transportation insecurity, compared to no transportation security, was significantly associated with having <6 WCVs (adjusted odds ratio [aOR] 1.64, 95% confidence interval [CI] 1.29, 2.09), ED visitation (aOR 1.45, 95%CI 1.14, 1.85), and hospitalization (aOR 1.52, 95%CI 1.13, 2.04). However, WCV attendance did not mediate associations between transportation insecurity and ED visits or hospitalizations.

Conclusion: Transportation insecurity was associated with fewer WCVs; however, WCV attendance did not mediate associations between acute healthcare usage and transportation insecurity. Future research could focus on mechanisms linking transportation insecurity to suboptimal health outcomes.