Neighborhood Social-Determinants-Of-Health Risk And Access To Pediatric Care
Neighborhood characteristics affect the health of resident children. Children in neighborhoods with high social-determinants-of-health risk (SDOH-risk) are more likely to need treatment for health conditions, increasing the importance of access to primary care providers (PCP). PCP access is affected by patient insurance status and ability to travel to the provider. Using the Institute-for-Health-Improvement's Population Health Model, the study goal was to examine whether neighborhood SDOH-risk was related to accessibility of healthcare.
METHODS: This was a secondary analysis integrating census data, primary care practice information and individual-level demographic and health data. Sample was 57 census tracts (CT) in Kalamazoo County. SDOH-risk was calculated using neighborhood factors differentiating CTs into high and low prematurity-rate quintiles. Accessibility was operationalized as geographically accessible (travel time), and insurance access (practice Medicaid acceptance). Geospatial analysis used ArcGIS and multivariable regression used SPSS with two-sided significance, alpha at .05.
RESULTS: SDOH-risk varies widely, with CT SDOH-risks ranging 0-6. Between the lowest and highest CTs, prematurity rates varied 23%. There are 31 primary care practices that serve children in Kalamazoo County; 9 have new-Medicaid-patient accepting practices.
Neighborhood SDOH-risk is unrelated to practice location in the CT (OR 1.054, CI 0.753 & 1.477, p=.757). There is no significant relationship between SDOH-risk and Medicaid acceptance (OR 1.254, CI 0.710 & 2.214, p=.435). SDOH-risk is unrelated to mean travel time, even after adjusting for insurance access (unstandardized beta -0.461, CI -1.280 & 0.358, p=.252).
CONCLUSION: Pediatric systems of care in Kalamazoo County do not appear to be geographically aligned with SDOH-risk.