260EMF Racial and Ethnic Disparities in Access to Pediatric Trauma Centers in the United States

Abstract

Injury is the leading cause of death and disability for children 1-18 years old, making access to pediatric trauma centers (PTC) crucial to decrease morbidity and mortality. Travel time to a trauma center exceeding the “golden hour” 60-minute transport time is associated with substantially increased mortality. Our objective was to describe the pediatric population with and without access to a PTC by geography and demographics in the United States (US). PTC locations were provided by the American Trauma Society. Road network and rotor-wing analysis determined which US Census Block Groups had ground and/or air access to a PTC within the 60-minute “golden hour” out-of-hospital time. Out-of-hospital time analysis incorporated time-to-arrival and on-scene time based on travel method and Block Group urbanicity. Analysis of the pediatric population at the Census Block Group level evaluated racial/ethnic disparities. At the national and state level, we calculated the 2020 pediatric population (</= 19 years old) with and without PTC access and stratified by race and ethnicity (American Indian, Asian, Black, Hispanic, Pacific Islander, and White). There are 157 PTC in the US. Of the US pediatric population, 44,811,022 (54.4%) have access to a PTC within a 60-minute ground transport time and 61,049,338 (74.1%) have access by air. Among those who do not have access, the race/ethnic breakdown is as follows (ground, air): American Indian (60.4%, 56.5%), Asian (13.0%, 11.0%), Black (25.6%, 22.0%), Hispanic (27.9% 23.1%), Pacific Islander (29.4% 39.0%), and White (35.3%, 28.7%). PTC access is sparse in the western US, by ground and air. No child in Alaska, Louisiana, Maine, Montana, New Mexico, and Wyoming has access to a PTC within 60 minutes. Only 5 states (New Jersey, Massachusetts, Connecticut, Rhode Island, and DC) had >90% of their pediatric population with 60-minute ground or air access. Significant disparities in access to PTC exist by geography and demographics in the US. The western US and American Indian pediatric population have the lowest percentage of access to a PTC by both ground and air transport. In 2020, over 21 million children in the US are at higher risk for poor trauma outcomes and/or inadequate treatment due to poor PTC access.