Disparities in geographic access to pediatric subspecialty care. 2008

Michelle L Mayer
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA. michelle_mayer@unc.edu

OBJECTIVE To identify correlates of geographic access to pediatric medical subspecialists in the United States and identify characteristics of populations at risk for poor geographic access. METHODS Geographic access was operationalized as distance to care. Using data from the American Board of Pediatrics and the Claritas' Pop-Facts Database, the straight-line distance between each zip code in the United States and the nearest subspecialist was calculated for each pediatric subspecialty using zip code centroids. Using 16 specialty-specific, random-effects multiple regression models, zip code characteristics associated with being farther from a subspecialty provider were identified. RESULTS Under-18 population, metropolitan status, and presence of a nearby teaching facility were associated with shorter distances to care across pediatric subspecialties. The proportion of the population below the federal poverty level was positively associated with greater distances to care. Zip codes in the Mountain and West North Central regions, likewise, were significantly farther from pediatric subspecialists, even when statistically controlling for other factors. CONCLUSIONS Pediatric populations at risk for poor geographic access to pediatric subspecialty care include those who reside in zip codes with high concentrations of poverty, in rural and small metropolitan areas, and in the Mountain and West North Central regions. The extent to which these distances create barriers to receipt of care is not established.

UI MeSH Term Description Entries
D010372 Pediatrics A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence.
D011204 Poverty Areas City, urban, rural, or suburban areas which are characterized by severe economic deprivation and by accompanying physical and social decay. Ghettos,Slums,Area, Poverty,Areas, Poverty,Ghetto,Poverty Area,Slum
D006297 Health Services Accessibility The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others. Access To Care, Health,Access to Care,Access to Contraception,Access to Health Care,Access to Health Services,Access to Medications,Access to Medicines,Access to Therapy,Access to Treatment,Accessibility of Health Services,Availability of Health Services,Contraception Access,Contraceptive Access,Medication Access,Accessibility, Health Services,Contraceptive Availability,Health Services Geographic Accessibility,Program Accessibility,Access to Cares,Access to Contraceptions,Access to Medication,Access to Medicine,Access to Therapies,Access to Treatments,Access, Contraception,Access, Contraceptive,Access, Medication,Accessibilities, Health Services,Accessibility, Program,Availability, Contraceptive,Care, Access to,Cares, Access to,Contraception, Access to,Contraceptive Accesses,Health Services Availability,Medication Accesses,Medication, Access to,Medicine, Access to,Medicines, Access to,Therapy, Access to,Treatment, Access to
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012424 Rural Population The inhabitants of rural areas or of small towns classified as rural. Rural Residence,Rural Communities,Rural Spatial Distribution,Communities, Rural,Community, Rural,Distribution, Rural Spatial,Distributions, Rural Spatial,Population, Rural,Populations, Rural,Residence, Rural,Rural Community,Rural Populations,Rural Residences,Rural Spatial Distributions
D014481 United States A country in NORTH AMERICA between CANADA and MEXICO.
D014505 Urban Population The inhabitants of a city or town, including metropolitan areas and suburban areas. Urban Residence,Urban Spatial Distribution,Distribution, Urban Spatial,Distributions, Urban Spatial,Population, Urban,Populations, Urban,Residence, Urban,Urban Populations,Urban Residences,Urban Spatial Distributions
D054625 Healthcare Disparities Differences in access to or availability of medical facilities and services. Disparities, Healthcare,Health Care Disparities,Health Care Inequalities,Healthcare Disparity,Healthcare Inequalities,Disparities, Health Care,Disparity, Health Care,Disparity, Healthcare,Health Care Disparity,Health Care Inequality,Healthcare Inequality,Inequalities, Health Care,Inequalities, Healthcare,Inequality, Health Care,Inequality, Healthcare

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