82 - Geographic Access to Perinatal Care in the United States

Publication Number: 3078.82

Ava Trueworthy, Vermont Oxford Network, Burlington, VT, United States; Erika M. Edwards, Vermont Oxford Network, Burlington, VT, United States

Background: While geographic access to obstetric (OB) care in the US is a well-researched issue, geographic access to the combination of OB and neonatal care (perinatal care) is not. If an infant requiring neonatal care is born in a hospital without a neonatal intensive care unit (NICU), the infant could be transferred to a hospital hundreds of miles from the mother. Furthermore, only certain NICUs offer a high level of care (HLC), defined as a Level 3 or 4 designation from the American Academy of Pediatrics. Infants with more complex cases often are transferred further than their lower-complexity counterparts. The physical, financial, and psychological burden this places on families is a serious concern, impacting outcomes for both mother and infant.

Objective: Evaluate geographic access to perinatal care across the US, determine availability of risk appropriate care, and identify patterns between distribution of care and birth rate.

Design/Methods: Datasets from 2021 of all hospitals in the US with OB units and NICUs were sourced from the American Healthcare Association and the organization Neonatology Solutions, respectively. Birth counts from 2021 were sourced from the US Census Bureau. Calculations were done in Python using the Geopy library and the Nominatim API. Maps were created in Python with the Plotly library.

Results: The average distance between an OB hospital and a NICU in 2021 was 19.10 miles (median: 2.0, maximum: 600.05). Of the 2,716 hospitals with OB units, 1,142 had a NICU in the same hospital. Of the 1,574 hospitals without NICUs, the average distance to the closest NICU was 32.96 miles (median: 24.80, maximum: 600.06). Of the 1,526 NICUs in the country, 861 of them were HLC NICUs. The average distance between an OB unit and an HLC NICU was 29.39 miles (median: 15.33, maximum: 722.03). This average increased to 38.43 miles when excluding hospitals with both an OB unit and NICU (median: 28.07, maximum: 722.03).

Conclusion(s): Geographic access to perinatal care varies across the country. The Midwest, Great Plains, and Southwest regions of the country see higher average distances between obstetric units and NICUs compared to the Eastern Seaboard and West Coast. Clearly, hospitals in rural areas are further from NICUs than hospitals in urban areas. Distances increase significantly when focusing on HLC NICUs, underscoring the need to improve access to risk appropriate care. However, we did not identify any areas of highly inequitably disparate birth rate and distance to NICU in our visualizations. Going forward, this is something that warrants region-specific analysis and more extensive investigation.

Geographic distribution of the distance between OB units and the closest NICU
A) Average distance between OB units and the closest NICU, by state. B) Average distance between OB unit and the closest HLC NICU, by state. C) Squares depict OB units; color depicts distance to the closest NICU. D) Squares depict OB units; color depicts distance to the closest HLC NICU.

Distribution of OB units and NICUs compared to births per county in 2021
A) US counties colored by number of births in 2021, overlayed with dots depicting each OB unit. Color of dots depicts distance to the closest NICU. B) US counties colored by number of births in 2021, overlayed with dots depicting each OB unit. Color of dots depicts distance to the closest HLC NICU.