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Disparities in Geographic Access to Pediatric Subspecialty Care

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Abstract

Purpose: 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.

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Notes

  1. Title V is a joint federal-state program, administered at the state level, to provide for a wide variety of maternal and child health programs that address national and state needs.

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Acknowledgements

The research was supported through grant number 1-K02-HS013309-01A1 from the Agency for Healthcare Research and Quality (ARHQ). The funding agency was not involved in the performance of the study. Special thanks go to the Sprint Manuscript Team in the Department of Health Policy and Administration and the Works in Progress Lunch at the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill for comments on previous drafts. Ann Howard was instrumental in performing distance analyses.

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Authors and Affiliations

  1. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Michelle L. Mayer

  2. Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, CB 7590, Chapel Hill, NC, 27599-7590, USA

    Michelle L. Mayer

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  1. Michelle L. Mayer
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Correspondence to Michelle L. Mayer.

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Mayer, M.L. Disparities in Geographic Access to Pediatric Subspecialty Care. Matern Child Health J 12, 624–632 (2008). https://doi.org/10.1007/s10995-007-0275-3

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  • DOI: https://doi.org/10.1007/s10995-007-0275-3

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