Abstract
Objective
To describe the relationship between neighborhood poverty and geographic access to
pediatric inpatient care.
Methods
This is a retrospective, cross-sectional study using 2017-2018 hospital and demographic
data, as well as geographic data from the 2010 census. Acute care hospitals in seventeen
states were included, comprising approximately one third of the national population.
The main outcome was distance to capable pediatric hospital care by neighborhood Area
Deprivation Index, both overall and by urbanicity.
Results
Median distance to pediatric hospital care increased linearly with poverty across
Area Deprivation Index national deciles (Pearson coefficient of 0.986; p<0.001). The
most advantaged neighborhoods were a median of 2.5 miles from the nearest pediatric
capable hospital (IQR 1.2-5.6) while those in the most disadvantaged were a median
of 13.8 miles away (IQR 3.3-35.9; p<0.001). The nearest hospital admitted children
in 51.17% (7,927) of advantaged neighborhoods (lowest national ADI quintile) and only
26.02% (3,729) of disadvantaged neighborhoods (highest national ADI quintile). The
association between poverty and median distance to care was observed in rural, suburban,
and urban CBGs (p<0.001 for all trends). In suburban neighborhoods, children from
the most disadvantaged neighborhoods were three times as likely as children from the
most advantaged neighborhoods to live more than twenty miles from pediatric inpatient
care (27.85%, 456,533 of children from bottom quintile neighborhoods vs. 9.24%, 259,787
of children from top quintile neighborhoods, p<0.001).
Conclusions
Distances to capable pediatric hospital care are greater from poor than affluent neighborhoods.
This carries potential implications for disparities in pediatric health outcomes.
Keywords
Abbreviations:
ADI (Area Deprivation Index), CBG (Census Block Group), HCI (Hospital Capability Index), pHCI (Pediatric Hospital Capability Index)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
January 29,
2023
Received:
June 8,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of Academic Pediatric Association
