Household income determines access to specialized pediatric chronic pain treatment in Germany.
BACKGROUND
Families with lower socioeconomic status (SES) often face problems with gaining access to health care services. Information is scarce on the relationship between SES and health care delivery for children suffering from chronic pain.


METHODS
Families presenting to a specialized pain center (N = 1,001) provided information on 'household income, 'parental education' and 'occupation' to aid the evaluation of their SES. To assess whether the SES of the clinical sample is representative of the general population, it was compared to data from a community sample (N = 14,558). For the clinical sample, travel distance to the clinic was described in relation to the 75% catchment area. Multiple logistic regression was used to analyze the association between SES and the journey from outside the catchment area.


RESULTS
The SES was significantly higher in the clinical sample than in the community sample. Within the clinical sample, the distance traveled to the pain center increased with increasing SES. The 75% catchment area was 143 miles for families with the highest SES and 78 miles for the lowest SES. 'Household income' predicted travel distance (OR 1.32 (1.12-1.56)). Education and occupational status were not significant predictors of travel from outside the catchment area.


CONCLUSIONS
In Germany, specialized care for children with chronic pain is subject to disparities in access. Future activities should focus on identifying barriers to access and seeking to prevent inequalities in specialized pediatric health care delivery. Increasing the number of specialized treatment facilities could improve access to specialized pediatric pain treatment, regardless of socioeconomic determinants.
German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health - School of Medicine, Dr.-Friedrich-Steiner-Str .5, 45711, Datteln, Germany. a.ruhe@deutsches-kinderschmerzzentrum.de.
Ann-Kristin
AK
Ruhe
German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health - School of Medicine, Dr.-Friedrich-Steiner-Str .5, 45711, Datteln, Germany.
Julia
J
Wager
Faculty of Economics and Social Sciences, University of Applied Sciences Osnabrück , Caprivistr. 30A, 49076, Osnabrück, Germany.
Gerrit
G
Hirschfeld
German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health - School of Medicine, Dr.-Friedrich-Steiner-Str .5, 45711, Datteln, Germany.
Boris
B
Zernikow
D000293:Adolescent; D002391:Catchment Area, Health; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data; D059350:Chronic Pain / Q000191:economics / Q000628:therapy*; D005260:Female; D005858:Germany; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007182:Income; D016015:Logistic Models; D009790:Occupations; D059408:Pain Management / Q000191:economics / Q000706:statistics & numerical data; D010290:Parents; D010372:Pediatrics; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014195:Travel
Chronic pain; Health care delivery; Income; Inequality; Pediatric; Socioeconomic status (SES); Specialized treatment