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J Pediatr Intensive Care
DOI: 10.1055/s-0044-1785668
Original Article

Social Disadvantage and Inequity in Access to Pediatric Critical Care Services for Children Living Remote from a Children's Hospital

Jordan L. Klein
1   Division of Pediatric Critical Care, University of Virginia School of Medicine, Charlottesville, Virginia, United States
,
Michael C. Spaeder
2   Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States
,
Ayush Doshi
3   Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States
,
Gary Y. Fang
2   Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States
,
Deborah Jeannean Carver
2   Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States
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Abstract

Regionalization of health care has created geographical distance between pediatric specialty services and children, with the potential for disparities in access to care. We investigated the association of state-level area deprivation index (S-ADI), a measure of socioeconomic disadvantage, and characteristics and outcomes in a cohort of children requiring unplanned hospital transfer to a quaternary care pediatric intensive care unit (PICU). We conducted a single-center retrospective cohort study of children requiring unplanned hospital transfer to the PICU at the University of Virginia Children's Hospital from July 1, 2019 to December 31, 2020, excluding planned transfers, transfers from another intensive care unit, and patients whose address could not be associated with an S-ADI. We collected demographic and clinical data as well as the S-ADI, an ordinal variable ranging from 1 to 10 with 10 representing the most disadvantage. We observed no differences in S-ADI based on patient sex, age, history of chronic medical conditions, or need for a medical device (tracheostomy, home ventilator, surgical feeding tube, cerebrospinal fluid shunt). We also did not observe differences in PICU or hospital length of stay based on S-ADI. We did observe for every one-point increase in S-ADI there was an associated increase of 8.6 miles (p < 0.001) in patient travel distance. Among patients from a higher S-ADI area, we observed increased severity of illness on PICU admission (p = 0.02) and case fatality as compared with patients from a lower S-ADI area (11 vs. 1.9%, p = 0.038). Children traveling the farthest for subspeciality pediatric critical care at our hospital had higher measures of socioeconomic disadvantage and severity of illness.

Keywords

health care inequality - rural health - health services accessibility - children - pediatric intensive care unit


Publication History

Received: 19 July 2023

Accepted: 13 March 2024

Article published online:
24 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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