O3306: Unequal Access: Geographic and Demographic Inequities in Pediatric General Surgical Care in the United States

Background: Access to specialized surgical care is a critical determinant of health outcomes for pediatric patients. Pediatric general surgeons provide essential care, but geographic barriers may limit accessibility, particularly in rural regions. This study aims to explore variations in distance to pediatric general surgeons across the United States using the 2020 Decennial Census data and the American Pediatric Surgical Association's 2020 membership list.

Project Description: A comprehensive list of pediatric general surgeons was obtained from the American Pediatric Surgical Association's 2020 member directory. The U.S. Decennial Census 2020 data was used to calculate straight-line distances between the zip codes of surgeons and census blocks. The study analyzed disparities in distance to pediatric surgical care with a focus on urbanization, stratifying results by age group, race/ethnicity, and geographic region.

Discussion: A total of 73,103,902 children across the United States and 1594 pediatric surgeons were included in the analysis, providing a ratio of approximately 45,862 children per pediatric surgeon. Pediatric surgeons were identified in 644 distinct zip codes. The average distance to a pediatric general surgeon was 49.6 miles (range 0-1199.2 miles). Notably, 89.5% of children lived within 60 miles of a pediatric surgeon, while 10.5% lived more than 60 miles away. Rural children experienced greater distances to care, with significant disparities seen in minority populations. Hispanic children, for example, had the largest average distance to care (109.9 miles), with 44.8% living over 60 miles away. In contrast, white children had an average distance of 57.42 miles, with 13.4% living more than 60 miles from a surgeon. Comparing data from 2010 to 2020, the proportion of children living over 60 miles from a pediatric general surgeon decreased slightly from 14.8% to 10.5%, this is due to both an increase in the number of pediatric surgeons as well as a slight decrease in the number of children in the United States.

Conclusion: This study highlights continued significant geographic disparities in access to pediatric general surgeons despite a continued increase in the number of pediatric surgeons practicing in the United States. This disparity is particularly seen in children living in rural areas and certain minority populations. Despite an overall decrease in the proportion of children living far from care, substantial gaps remain with regard to ethnicity. Addressing these disparities through regionalization and improved distribution of surgical resources is critical to ensuring equitable access to care for all children. There has been a significant improvement in the ratio of children to pediatric surgeons, however, this ratio remains much higher than that seen in adult general surgery.