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Am J Perinatol 2024; 41(S 01): e1091-e1098
DOI: 10.1055/s-0042-1760431
Original Article

Factors Associated with Transfer Distance from Birth Hospital to Repair Hospital for First Surgical Repair among Infants with Myelomeningocele in California

Vijaya Kancherla
1   Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
,
Chen Ma
2   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
,
Neha J. Purkey
3   Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
,
Susan R. Hintz
2   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
4   California Perinatal Quality Care Collaborative, Stanford, California
,
Henry C. Lee 
2   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
4   California Perinatal Quality Care Collaborative, Stanford, California
,
Gerald Grant
5   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
,
Suzan L. Carmichael
2   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
6   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, California
› Author Affiliations
Funding This study received its financial support from the National Institute on Minority Health and Health Disparities (grant number: R01 MD007796).
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Abstract

Objective The objective of our study was to examine factors associated with distance to care for first surgical repair among infants with myelomeningocele in California.

Study Design A total of 677 eligible cases with complete geocoded data were identified for birth years 2006 to 2012 using data from the California Perinatal Quality Care Collaborative linked to hospital and vital records. The median distance from home to birth hospital among eligible infants was 9 miles, and from birth hospital to repair hospital was 15 miles. We limited our analysis to infants who lived close to the birth hospital, creating two study groups to examine transfer distance patterns: “lived close and had a short transfer” (i.e., lived <9 miles from birth hospital and traveled <15 miles from birth hospital to repair hospital; n = 92), and “lived close and had a long transfer” (i.e., lived <9 miles from birth hospital and traveled ≥15 miles from birth hospital to repair hospital; n = 96). Log-binomial regression was used to estimate crude and adjusted risk ratios (aRRs and 95% confidence intervals (CIs). Selected maternal, infant, and birth hospital characteristics were compared between the two groups.

Results We found that low birth weight (aRR = 1.44; 95% CI = 1.04, 1.99) and preterm birth (aRR = 1.41; 95% CI = 1.01, 1.97) were positively associated, whereas initiating prenatal care early in the first trimester was inversely associated (aRR = 0.64; 95% CI = 0.46, 0.89) with transferring a longer distance (≥15 miles) from birth hospital to repair hospital. No significant associations were noted by maternal race-ethnicity, socioeconomic indicators, or the level of hospital care at the birth hospital.

Conclusion Our study identified selected infant factors associated with the distance to access surgical care for infants with myelomeningocele who had to transfer from birth hospital to repair hospital. Distance-based barriers to care should be identified and optimized when planning deliveries of at-risk infants in other populations.

Key Points

  • Low birth weight predicted long hospital transfer distance.

  • Preterm birth was associated with transfer distance.

  • Prenatal care was associated with transfer distance.

Keywords

access to health service - California - distance - care disparity - myelomeningocele - open spina bifida

Supplementary Material



Publication History

Received: 24 March 2022

Accepted: 28 November 2022

Article published online:
16 January 2023

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