Factors associated with travel time and distance to access hospital care among children with spina bifida

Background:  Using a Geographic Information Systems (GIS)-based approach, we examined travel time and distance and factors associated with them to access hospital care for children with spina bifida (SB).

Methods:  This was a statewide, population-based study 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) and children ages 1-4 years.  Using the Florida Department of Transportation 2007 road network, we calculated one-way travel time and distance to access hospital care.  Using logistic regression (<30 minutes or miles, reference vs. >30 minutes or miles), we examined selected factors associated with travel time and distance, including presence of hydrocephalus and isolated (no other major birth defect) vs. non-isolated SB.

Results:  Of 612 children, 85.8% lived in urban areas; 14.2% in rural areas.  One-way mean (median) hospital travel time during infancy and ages 1-4 years were 45.1 (25.9) and 39.8 (22.7) minutes, respectively.  Infants with non-isolated SB and hydrocephalus traveled the longest to access hospital care (mean: 60.8 minutes; median: 34.2 minutes).  During infancy, non-isolated SB, lower maternal education, and rural residence were associated with lower likelihood of traveling ≤30 minutes to hospitals.  For all children, maternal minority race/ethnicity was associated with greater likelihood of traveling ≤30 minutes.

Conclusions:  Results suggest infants with non-isolated SB and hydrocephalus had long travel times.  Birth defects registry data and GIS methods are useful for evaluating access to care.