Access to pediatric extracorporeal membrane oxygenation according to neighborhood-level determinants of health

Unequal geographic distribution of neighborhood resources and healthcare services can exacerbate disparities in access to care. In this study, we evaluate geospatial access to pediatric extracorporeal membrane oxygenation (ECMO) services in the U.S., examining differences by neighborhood-level social advantage, racial/ethnic composition, and urbanicity versus rurality. We conducted a cross-sectional geospatial analysis to define catchment areas based on 0–30, 31–60, 61–120 and > 120-minute drive-times from pediatric ECMO centers. For each catchment, we calculated mean values for key neighborhood characteristics: the Child Opportunity Index (COI), percent underrepresented races/ethnicities (%UR), and urban versus rural classification. We compared means across drive-time zones, and prevalence ratios (PR) for residing > 60-minute from ECMO centers. PR based on dichotomized COI, %UR, and rurality calculate the prevalence of > 60-minute drive-times for low COI/%UR verses high, and for rural versus urban areas. Overall, 30.5% of children reside > 60-minutes from pediatric ECMO services with 9.7% residing > 120-minutes away. Areas > 60-minutes from ECMO had lower COI compared with those close (difference in mean COI: 7.0 (95%CI 5.1, 8.3). The prevalence of > 60-minute drive-times was 150% higher for the lowest vs. highest COI quintile areas (PR: 2.5 [1.8, 3.4]). In contrast, areas located < 60-minutes from ECMO services had 8.6% higher %UR. Prevalence of > 60-minute drive-times was 200% higher in rural versus urban catchments (PR: 3.1 [2.7, 3.5]). In conclusion, children living further from pediatric ECMO services tend to have fewer neighborhood resources and are more likely to reside in rural areas, underscoring the need for targeted approaches to promote equitable access to healthcare.