Highlights
- •Geographic barriers to pediatric surgical care exist in the United States.
- •Distance traveled to care and rurality are associated with worse health indicators.
- •Children traveling >120 min for surgery have higher odds of postoperative mortality and morbidity.
- •Children from rural communities have higher odds of postoperative morbidity.
Abstract
Introduction
Rurality and distance traveled for healthcare are associated with worse pediatric
health indicators.
Methods
We retrospectively analyzed patients ages 0–21 at a quaternary pediatric surgical
facility with a large rural catchment area between 1/1/2016-12/31/2020. Patient addresses
were designated as metropolitan or non-metropolitan. 60- and 120-min driving rings
from our institution were calculated. Logistic regression assessed the effect of rurality
and distance traveled for care on postoperative mortality and serious adverse events
(SAE).
Results
Among 56,655 patients, 84.3% were from metropolitan areas, 8.4% from non-metropolitan
areas, and 7.3% could not be geocoded. 64% were within 60-min driving and 80% within
120-min. On univariable regression, patients living >120-min experienced 59% (95%
CI: 1.09, 2.30) increased odds of mortality and 97% (95% CI: 1.84, 2.12) increased
odds of SAE compared to those <60-min. Non-metropolitan patients experienced 38% (95%
CI: 1.26, 1.52) increased odds of a serious postoperative event compared to metropolitan
patients.
Discussion
Efforts to improve geographic access to pediatric care are needed to mitigate the
impact of rurality and travel time on inequitable surgical outcomes.
Keywords
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Article info
Publication history
Published online: February 13, 2023
Accepted:
February 13,
2023
Received in revised form:
January 13,
2023
Received:
November 25,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
