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A model for geographic and sociodemographic access to care disparities for adults with congenital heart disease

2019; Wiley; Volume: 14; Issue: 5 Linguagem: Inglês

10.1111/chd.12819

1747-0803

Katherine B. Salciccioli, Abiodun Oluyomi, Philip J. Lupo, Peter Ermis, Keila N. Lopez,

Renal and Vascular Pathologies

Congenital Heart DiseaseVolume 14, Issue 5 p. 752-759 ORIGINAL ARTICLE A model for geographic and sociodemographic access to care disparities for adults with congenital heart disease Katherine B. Salciccioli MD, Corresponding Author Katherine B. Salciccioli MD kbohard@gmail.com orcid.org/0000-0003-4474-6165 Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas Correspondence Katherine B. Salciccioli MD, Section of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX 77030. Email: kbohard@gmail.comSearch for more papers by this authorAbiodun Oluyomi PhD, Abiodun Oluyomi PhD Environmental Health Service, Section of General Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TexasSearch for more papers by this authorPhilip J. Lupo PhD, MPH, Philip J. Lupo PhD, MPH Section of Hematology and Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TexasSearch for more papers by this authorPeter R. Ermis MD, Peter R. Ermis MD Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TexasSearch for more papers by this authorKeila N. Lopez MD, MPH, Keila N. Lopez MD, MPH Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TexasSearch for more papers by this author Katherine B. Salciccioli MD, Corresponding Author Katherine B. Salciccioli MD kbohard@gmail.com orcid.org/0000-0003-4474-6165 Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas Correspondence Katherine B. Salciccioli MD, Section of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, 6651 Main Street, E 1920, Houston, TX 77030. Email: kbohard@gmail.comSearch for more papers by this authorAbiodun Oluyomi PhD, Abiodun Oluyomi PhD Environmental Health Service, Section of General Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TexasSearch for more papers by this authorPhilip J. Lupo PhD, MPH, Philip J. Lupo PhD, MPH Section of Hematology and Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TexasSearch for more papers by this authorPeter R. Ermis MD, Peter R. Ermis MD Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TexasSearch for more papers by this authorKeila N. Lopez MD, MPH, Keila N. Lopez MD, MPH Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TexasSearch for more papers by this author First published: 30 July 2019 https://doi.org/10.1111/chd.12819Citations: 25Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Background Follow-up at a regional adult congenital heart disease (ACHD) center is recommended for all ACHD patients at least once per the 2018 ACC/AHA guidelines. Other specialties have demonstrated poorer follow-up and outcomes correlating with increased distance from health care providers, but driving time to regional ACHD centers has not been examined in the US population. Objective To identify and characterize potential disparities in access to ACHD care in the US based on drive time to ACHD centers and compounding sociodemographic factors. Methods Mid- to high-volume ACHD centers with ≥500 outpatient ACHD visits and ≥20 ACHD surgeries annually were included based on self-reported, public data. Geographic Information System mapping was used to delineate drive times to ACHD centers. Sociodemographic data from the 2012-2016 American Community Survey (US Census) and the Environmental Systems Research Institute were analyzed based on drive time to nearest ACHD center. Previously established CHD prevalence estimates were used to estimate the similarly located US ACHD population. Results Nearly half of the continental US population (45.1%) lives >1 hour drive to an ACHD center. Overall, 39.7% live 1-4 hours away, 3.4% live 4-6 hours away, and 2.0% live >6 hours away. Hispanics were disproportionately likely to live a >6 hour drive to a center (p < .001). Compared to people with 6 hours away have higher proportions of uninsured adults (29% vs. 18%; p < .001), households below the federal poverty level (19% vs. 13%; p < .001), and adults with less than college education (18% vs. 12%; p < .001). Conclusions We estimate that ~45% of the continental US population lives >1 hour to an ACHD center, with 5.4% living >4 hours away. Compounding barriers exist for Hispanic, uninsured, lower socioeconomic status, and less-educated patients. These results may help drive future policy changes to improve access to ACHD care. CONFLICT OF INTEREST The authors have no conflicts of interest. Citing Literature Volume14, Issue5September/October 2019Pages 752-759 RelatedInformation