(101) Distribution of Pediatric Intensive Care Units According to Social Drivers of Health

Introduction: Geographic and social barriers impact healthcare access. We studied United States PICU capacity distribution via geographic information system (GIS) and market share (MS) approaches to examine how SDoH influence access.

Methods: GIS analyses classify drive-times around hospitals with ≥1 PICU bed, defining a 60-min range as direct access (DA). MS allocates PICU bed capacity to local areas using Healthcare Utilization Project data for hospitals with a high proportion of pediatric discharges, to reflect specialized care that children actually tend to use. Capacity was supplemented with measures of hospital resources (full time equivalent [FTE] employees, capital, expenditure per bed) and quality (central line infection, CLI) rates. To test for disparate PICU access by SDoH we studied how drive-times and local capacity vary by race and ethnicity including percent underrepresented (%UR), average education or family income level, population density, and child opportunity index (COI range 0-100, higher indicates social advantage).

Results: While 80% of children have DA to 1 of 337 PICUs, 5% reside >2 hours away. Nationally, neighborhoods with DA to PICU services have higher COI (mean difference 6.1 [95%CI 4.5-7.7]). DA was associated with higher %UR, though relationships differed substantially between states. Certain population dense areas were identified with long drive-times. Using MS, PICU capacity was 11.1 beds/10000 residents < 20 years. Relative to non-Hispanic white, non-Hispanic Black children lived in areas with less PICU capacity while Hispanic children had higher local capacity. Minimal capacity differences existed by COI, education, or income. Hispanic or non-Hispanic Black (vs non-Hispanic white) children or those with lower COI, education, or income accessed less resourced hospitals (lower FTE, capital, and expenditure per bed). CLBSI rates were highest in non-Hispanic Black and lowest in Hispanic and Asian children, with no difference for other SDoH.

Conclusions: Children living further from PICUs have relative social disadvantage. Non-Hispanic Black children have the least access to PICU capacity. Capacity is less resourced for underrepresented racial and ethnic groups and socially disadvantaged families. Resource allocation requires critical review for equitable access.