Abstract
BackgroundPediatric primary care visits are a foundational element in the health maintenance of children. Differential access may be a driver of racial inequities in health. We hypothesized that pediatric primary care accessibility would be lowest in neighborhoods with higher proportion of non-Hispanic Black residents.MethodsAnnual ratios (2008–2016) of providers to pediatric population were calculated by census tract in Philadelphia, Pennsylvania. Marginal logistic regression was used to estimate the independent association between neighborhood racial composition and access to pediatric primary care controlling for confounders.ResultsIn general, low access to care was associated with greater neighborhood disadvantage (e.g., SES, % poverty, % public insurance). After controlling for neighborhood indicators of disadvantage, risk of being in the lowest quintile of access significantly increased as the percent of non-Hispanic Black residents increased.ConclusionA new measure of pediatric primary care accessibility demonstrates a persistent disparity in primary care access for predominantly non-Hispanic Black neighborhoods.
Highlights
Pediatric primary care visits are a foundational element in the health maintenance of children
As part of a larger study evaluating individual- and neighborhood-level characteristics associated with pediatric unplanned hospitalization, we evaluated spatial accessibility from 2008 to 2016
In order to evaluate whether the neighborhood-level covariates were associated with access to pediatric primary care, we summarized neighborhood-level characteristics by quintile of spatial accessibility
Summary
Pediatric primary care visits are a foundational element in the health maintenance of children. Marginal logistic regression was used to estimate the independent association between neighborhood racial composition and access to pediatric primary care controlling for confounders. Ample evidence suggests that accessible primary care is necessary to maintain and improve the health of populations [2]. Access to care can be defined as an individual or population’s capacity to gain entry into the health system. It has spatial, organizational, and financial dimensions [3]. In an era of expanded financial accessibility through State Children’s Health Insurance Programs and the Affordable Care Act [4], increased emphasis should be placed on assuring other types of access, such as spatial
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