Factors Associated with Travel Time and Distance to Access Hospital Care Among Infants with Spina Bifida.
OBJECTIVE
Using geographic information systems (GIS), we examined travel time and distance to access hospital care for infants with spina bifida (SB).


METHODS
This study was a statewide, population-based analysis of Florida-born children with SB, 1998-2007, identified by the Florida Birth Defects Registry and linked to hospitalizations. We geocoded maternal residence at delivery and identified hospital locations for infants (<1 year). Using 2007 Florida Department of Transportation road data, we calculated one-way mean travel time and distance to access hospital care. We used Poisson regression to examine selected factors associated with travel time and distance [≤30 vs. >30 min/miles (reference)], including presence of hydrocephalus and SB type [isolated (no other major birth defect) versus non-isolated SB].


RESULTS
For 612 infants, one-way mean (median) travel time was 45.1 (25.9) min. Infants with both non-isolated SB and hydrocephalus traveled longest to access hospitals (mean 60.8 min/48.5 miles; median 34.2 min/26.9 miles). In adjusted results, infants with non-isolated SB and whose mothers had a rural residence were less likely to travel ≤30 min to hospitals. Infants born to mothers in minority racial/ethnic groups were more likely to travel ≤30 min.


CONCLUSIONS
Birth defects registry data and GIS-based methods can be used to evaluate geographic accessibility to hospital care for infants with birth defects. Results can help to identify geographic barriers to accessing hospital care, such as travel time and distance, and inform opportunities to improve access to care for infants with SB or other special needs.
South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stonebridge Drive, Suite 102, Columbia, SC, 29210, USA. radclife@mailbox.sc.edu.
Elizabeth
E
Radcliff
Department of Geography and Earth Sciences and Center for Applied GIScience, College of Liberal Arts and Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA.
Eric
E
Delmelle
Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
Russell S
RS
Kirby
Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC, USA.
Sarah B
SB
Laditka
Florida Department of Health, Florida Birth Defects Registry, Tallahassee, FL, USA.
Jane
J
Correia
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Cynthia H
CH
Cassell
Access to care; Children with special needs; GIS; Spina bifida; Travel