Hospital accessibility and infant death risk

Abstract

This study of all 4889 infant deaths within the cohort of all 287 993 births in Cumbria, northwest England (1950-93), found no evidence of an increased risk of infant death with greater travel time to hospitals. R isk of mortality from asthma increases with distance from hospital. 1 In the developing world increasing distance from hospital has been shown to be a risk factor for perinatal mortality.2 With respect to the UK, Parker and colleagues 3 found no evidence of an increased risk of stillbirth in relation to increasing distance from maternity hospitals in West Cumbria. Little is known about the risk of infant mortality in relation to hospital accessibility.Accessibility to hospital can be defined in a number of ways: straight-line distance between the hospital and home; road travel distance; road travel time from home to hospital. In this study a geographical information system (GIS) was used to model road travel time to hospital. The aim of the study was to investigate whether geographical accessibility to hospitals affected the risk of infant mortality in Cumbria, northwest England, 1950-93. In addition, we investigated stillbirth risk in Cumbria in relation to hospital accessibility using a larger dataset than that considered by Parker and colleagues. 3 METHODSThis study used the Cumbrian Births Database (CBD), which comprises all 283 668 live births, 4325 stillbirths and 4889 infant deaths in Cumbria, 1950-93 (described in Dummer and colleagues 4 ). Postcode at birth, social class, birth order, multiple births, and year of birth were coded for the cohort and grid references of all births were derived from the postcode at birth. 4 Infant deaths were coded into early neonatal (0-6 days old), neonatal (0-27 days old), and postneonatal (28 days to 1 year).The grid reference and details of all hospitals in Cumbria open between 1950 and 1993 were captured in the GIS database (see fig 1). The road network and boundaries of built-up areas were also captured in the GIS. A travel time to hospital surface of isochrones-lines of equal travel time 5 -was generated by combining the road network, the location of built-up areas (which affects vehicle speeds on the roads), and the location of all hospitals. For the infant death analysis, general hospitals and hospitals with paediatric facilities were incorporated. For the stillbirth analysis all hospitals with a maternity facility were incorporated. Hospital locations included Lancaster Royal Infirmary, which is outside Cumbria but provides maternity and paediatric facilities for those in the south of the county. The grid reference of each birth was used to geographically locate individual births. Travel time to hospital, in relation to hospitals open in the year of birth, was derived for all individual live and still births.Logistic regression was used to investigate the risk of infant mortality (early neonatal, neonatal, and postneonatal deaths) and stillbirth in relation to accessibility to hospital, adjusting for demographic risk factors (year of birth, social class...

Geographic Accessibility to Health Services and Neonatal Mortality Among Very-Low Birthweight Infants in South Carolina

“…This study is consistent with Combier et al (2013), Dummer and Parker (2004), and Moisi et al (2010) that travel time is not associated with neonatal mortality, while studies by Gryzbowski et al (2011), Okwaraji et al (2012, Ravelli et al (2011), andShoeps et al (2011) found a significant association with under-5 mortality and perinatal mortality (stillbirths and neonatal deaths). However, direct comparisons are not warranted for several reasons.…”

“…In such studies, pedestrian travel was the most common form of transport (Combier et al, 2013;Moisi et al, 2010;Okwaraji et al, 2012). The majority of studies consisted of a much larger sample size (Combier et al, 2013;Dummer & Parker, 2004;Grzybowski et al, 2011;Moisi et al, 2010;Okwaraji et al, 2012;Ravelli et al, 2011). Consistent with Combier et al (2013), and Grzybowski et al (2011), we excluded births less than 20 weeks gestation.…”

“…Some other studies have evaluated the impact of road distance traveled to health facilities on either perinatal, neonatal, or infant mortality in both developed (Lisonkova et al, 2011;Pasquier et al, 2007;Pilkington, Blondel, Drewniak, & Zeitlin, 2014) and developing (Armstrong Schellenberg et al, 2008;Kashima et al, 2012;Lohela, Campbell, & Gabrysch, 2012;Malqvist, Sohel, Do, Eriksson, & Persson, 2010) countries but with varied results. Very few studies have used a more accurate measure, namely travel time to health care services, and studied its impact on mortality in infancy (Combier et al, 2013;Dummer & Parker, 2004;Grzybowski, Stoll, & Kornelsen, 2011;Moisi et al, 2010;Okwaraji, Cousens, Berhane, Mulholland, & Edmond, 2012;Ravelli et al, 2011;Schoeps, Gabrysch, Niamba, Sie, & Becher, 2011). Of those studies that utilized a distance-or time-based measure of access, there were vast differences in sample size, exclusion/inclusion criteria, and geographic region of study.…”

“…Not many of those studies have utilized a time-based measure of access, and none have examined its impact on neonatal mortality among a high-risk infant group. Of the seven studies analyzed in this literature review, three concluded a null association (Combier et al, 2013;Dummer & Parker, 2004;Okwaraji et al, 2012) between the travel time to nearest perinatal hospital or actual delivery facility and infant death, while four studies found positive associations (Grzybowski et al, 2011;Moisi et al, 2010;Ravelli et al, 2011;Schoeps et al, 2011) even after adjusting for confounders.…”

“…Developed Countries Dummer and Parker (2004) reported an overall null association between travel time from home to the nearest general or pediatric hospital and risk of infant death in England for all time periods : 1950-1959, 1960-1969, 1970-1979, 1980-1993. This was a population-based cross-sectional study that utilized the Cumbrian Births Database (CBD) which comprises live births, stillbirths, and infant deaths. A total of 4,489 infant deaths occurred in this cohort of 287,993 births.…”