Access to Pediatric Bed Capacity According to Social Determinants of Health: All Beds Are Not Created Equal.

Objective: To study pediatric inpatient hospital capacity and resources, characterizing differences according to Social Determinants of Health (SDoH) using market share techniques.

Study design: This cross-sectional study uses nonelective inpatient discharges (≥1 month to ≤19 years) from Healthcare Cost and Utilization Project and American Hospital Association surveys to derive hospital capacity and resources/capability. We include US hospitals with ≥1 pediatric bed and ≥1 pediatric discharge and calculate per bed capital, expenditure, and staffing, transfer rates, payer-mix, and adjusted central line-associated blood stream infection rate. We utilize actual discharge data to improve upon traditional geospatial access analyses that assume all patients receive care close to home. SDoH are derived from American Community Survey measures (family income, race and ethnicity, and urban vs rural) and Child Opportunity Index (COI).

Results: Using 1 118 502 discharges across 1404 hospitals, mean pediatric bed capacity was 3.26 beds per 10 000 pediatric-aged residents (95% CI: 3.24-3.29). Capacity was similar across racial and ethnic groups, although socially disadvantaged (low income or COI) areas had higher capacity. Hospitals serving non-Hispanic/Latino Black and Hispanic/Latino children, children from socially disadvantaged communities, and rural areas had lower capital, expenditure, and staff per bed; higher transfer rates; and served more Medicaid enrollees. Hospitals serving very-high COI areas had $284 000 greater expenditure per bed (vs very low) and a 16% lower proportion of Medicaid patients. Central line-associated blood stream infection rates did not substantively differ by SDoH.

Conclusions: Although pediatric bed capacity was evenly distributed according to SDoH, hospitals serving under-represented, disadvantaged, and rural communities had less capability and resource availability. Future work is required to guide equity-oriented resource allocation.