Childhood health status and its association with geographic risk factors and physician distribution

Objective: To describe childhood health status at the Block Group (BG) level (BG is a geographic entity with area size between a Census tract and a Census Block) and to explore potential geographic factors that may contribute to poor childhood health.

Methods: Administrative claims data for commercially insured members aged 1-18 years within a southeastern Managed Care Organization were studied.

The concurrent Diagnostic Cost Group Analysis (DCG) risk score was used as a surrogate for child health status. Member data were aggregated to the BG level for analysis. Using Geographic Information System (GIS), number of applicable providers within 20 miles of member's home (PCP_COUNT), provider to member ratio (PCP/MEMBER), and the ratio of provider to population up to 21 years of age within 20 miles of member's home (PCP/POP21YR) were calculated. The urban or rural status was defined using 2000 U.S. Census data.

Results: 21% of total 3,880 BG had a DCG risk >1 which indicated poorer general health than the average. The risk for members living in an urbanized area was lower than children living in a rural area (1.08 versus 1.11, p=0.001). The PCP_COUNT was greater in urban area than in rural area (2230 versus 541, p<0.0001). Provider density in terms of PCP/MEMBER and PCP/POP21YR were significantly greater in urban compared to rural areas (0.129 versus 0.098 and 0.014 versus 0.012, respectively).

Conclusion: Using GIS, we quantitatively measured members' access to care. These information should be considered when determining drivers of health status and establishing sufficient provider networks.