Proximity of pediatric genetic services to children with birth defects in Texas

BACKGROUND Children with birth defects may face significant geographic barriers accessing medical care and specialized services. Using a Geographic Information Systems–based approach, one-way travel time and distance to access medical care for children born with spina bifida was estimated. METHODS Using 2007 road information from the Florida Department of Transportation, we built a topological network of Florida roads. Live-born Florida infants with spina bifida during 1998 to 2007 were identified by the Florida Birth Defects Registry and linked to hospital discharge records. Maternal residence at delivery and hospitalization locations were identified during the first year of life. RESULTS Of 668 infants with spina bifida, 8.1% (n = 54) could not be linked to inpatient data, resulting in 614 infants. Of those 614 infants, 99.7% (n = 612) of the maternal residential addresses at delivery were successfully geocoded. Infants with spina bifida living in rural areas in Florida experienced travel times almost twice as high compared with those living in urban areas. When aggregated at county levels, one-way network travel times exhibited statistically significant spatial autocorrelation, indicating that families living in some clusters of counties experienced substantially greater travel times compared with families living in other areas of Florida. CONCLUSION This analysis demonstrates the usefulness of linking birth defects registry and hospital discharge data to examine geographic differences in access to medical care. Geographic Information Systems methods are important in evaluating accessibility and geographic barriers to care and could be used among children with special health care needs, including children with birth defects.

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Modeling travel impedance to medical care for children with birth defects using Geographic Information Systems

Delmelle

Cassell

Dony

et al. 2013

“…In a different study, researchers evaluated the distance of residential addresses of children born 1999 to 2004 with major and chromosomal birth defects in Texas from pediatric clinical genetic service providers. The authors found disparities in geographic access to services among these children (Case et al, 2008). These studies illustrate that GIS is a convenient and readily available alternative to surveys in identifying geographic barriers to care for children with birth defects, such congenital heart defects and chromosomal defects that require coordinated, specialized care.…”

Section: Discussionmentioning

confidence: 99%

“…Mean, median, ranges, and total travel distance and time were reported. One-way travel distance and time were categorized based on frequency distributions, meaningful cut-points for analyses, and the literature on distance and time to medical care for birth defects and other medical conditions, such as cancer (Kuehn et al, 2007; Case et al, 2008; Huang et al, 2009; Henry et al, 2011; Fixler et al, 2012; Pinto et al, 2012). Travel distance was analyzed in four categories, 0 to 30 miles, 31 to 60 miles, 61 to 90 miles, and greater than 90 miles.…”

Section: Methodsmentioning

confidence: 99%

“…Only a few studies have specifically examined geographic barriers for children with birth defects using birth defects registry data, which examined the location of services and its effect on survival and health service use (Case et al, 2008; Cassell et al, 2009; Fixler et al, 2012). For children with OFC, only a few studies have examined geographic barriers to primary cleft and craniofacial care among children with OFC.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with distance and time traveled to cleft and craniofacial care

Cassell

Krohmer²,

Méndez

et al. 2013

BACKGROUND Information on travel distance and time to care for children with birth defects is lacking. We examined factors associated with travel distance and time to cleft care among children with orofacial clefts. METHODS In 2006, a mail/phone survey was administered in English and Spanish to all resident mothers of children with orofacial clefts born 2001 to 2004 and identified by the North Carolina birth defects registry. We analyzed one-way travel distance and time and the extent to which taking a child to care was a problem. We used multivariable logistic regression to examine the association between selected sociodemographic factors and travel distance (≤60 miles and >60 miles) and time (≤60 min and >60 min) to cleft care. RESULTS Of 475 eligible participants, 51.6% (n = 245) responded. Of the respondents, 97.1% (n = 238) were the child’s biological mother. Approximately 83% (n = 204) of respondents were non-Hispanic White; 33.3% (n = 81) were college educated; and 50.0% (n = 115) had private health insurance. One-way mean and median travel distances were 80 and 50 miles, respectively (range, 0–1058 miles). One-way mean and median travel times were 92 and 60 min, respectively (range, 5 min to 8 hr). After adjusting for selected sociodemographics, travel distance varied significantly by maternal education, child’s age, and cleft type. Travel time varied significantly by child’s age. Approximately 67% (n = 162) reported taking their child to receive care was not a problem. CONCLUSION Approximately 48% of respondents traveled > 1 hr to receive cleft care. Increasing access to care may be important for improving health outcomes among this population.

Proximity to Pediatric Cardiac Surgical Care among Adolescents with Congenital Heart Defects in 11 New York Counties

Sommerhalter

Insaf

Akkaya-Hocagil

et al. 2017

Background Many individuals with congenital heart defects (CHDs) discontinue cardiac care in adolescence, putting them at risk of adverse health outcomes. Because geographic barriers may contribute to cessation of care, we sought to characterize geographic access to comprehensive cardiac care among adolescents with CHDs. Methods Using a population-based, 11-county surveillance system of CHDs in New York, we characterized proximity to the nearest pediatric cardiac surgical care center among adolescents aged 11 to 19 years with CHDs. Residential addresses were extracted from surveillance records documenting 2008 to 2010 healthcare encounters. Addresses were geocoded using ArcGIS and the New York State Street and Address Maintenance Program, a statewide address point database. One-way drive and public transit time from residence to nearest center were calculated using R packages gmapsdistance and rgeos with the Google Maps Distance Matrix application programming interface. A marginal model was constructed to identify predictors associated with one-way travel time. Results We identified 2522 adolescents with 3058 corresponding residential addresses and 12 pediatric cardiac surgical care centers. The median drive time from residence to nearest center was 18.3 min, and drive time was 30 min or less for 2475 (80.9%) addresses. Predicted drive time was longest for rural western addresses in high poverty census tracts (68.7 min). Public transit was available for most residences in urban areas but for few in rural areas. Conclusion We identified areas with geographic barriers to surgical care. Future research is needed to determine how these barriers influence continuity of care among adolescents with CHDs.