Delmelle Eric M, Cassell Cynthia H, Dony Coline, Radcliff Elizabeth, Tanner Jean Paul, Siffel Csaba, Kirby Russell S
Department of Geography and Earth Sciences and Center for Applied GIScience, College of Liberal Arts and Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina.
Birth Defects Res A Clin Mol Teratol. 2013 Oct;97(10):673-84. doi: 10.1002/bdra.23168. Epub 2013 Sep 2.
Children with birth defects may face significant geographic barriers accessing medical care and specialized services. Using a Geographic Information Systems-based approach, one-way travel time and distance to access medical care for children born with spina bifida was estimated.
Using 2007 road information from the Florida Department of Transportation, we built a topological network of Florida roads. Live-born Florida infants with spina bifida during 1998 to 2007 were identified by the Florida Birth Defects Registry and linked to hospital discharge records. Maternal residence at delivery and hospitalization locations were identified during the first year of life.
Of 668 infants with spina bifida, 8.1% (n = 54) could not be linked to inpatient data, resulting in 614 infants. Of those 614 infants, 99.7% (n = 612) of the maternal residential addresses at delivery were successfully geocoded. Infants with spina bifida living in rural areas in Florida experienced travel times almost twice as high compared with those living in urban areas. When aggregated at county levels, one-way network travel times exhibited statistically significant spatial autocorrelation, indicating that families living in some clusters of counties experienced substantially greater travel times compared with families living in other areas of Florida.
This analysis demonstrates the usefulness of linking birth defects registry and hospital discharge data to examine geographic differences in access to medical care. Geographic Information Systems methods are important in evaluating accessibility and geographic barriers to care and could be used among children with special health care needs, including children with birth defects.
出生缺陷儿童在获得医疗护理和专业服务方面可能面临巨大的地理障碍。采用基于地理信息系统的方法，估算了脊柱裂患儿获得医疗护理的单程出行时间和距离。
利用佛罗里达州交通部2007年的道路信息，构建了佛罗里达州道路的拓扑网络。通过佛罗里达州出生缺陷登记处识别出1998年至2007年在佛罗里达州出生且患有脊柱裂的活产婴儿，并将其与医院出院记录相链接。确定了出生时母亲的居住地以及婴儿一岁内的住院地点。
在668名脊柱裂婴儿中，8.1%（n = 54）无法与住院数据相链接，最终纳入分析的有614名婴儿。在这614名婴儿中，99.7%（n = 612）出生时母亲的居住地址成功进行了地理编码。与居住在城市地区的脊柱裂婴儿相比，居住在佛罗里达州农村地区的婴儿出行时间几乎高出一倍。在县级层面进行汇总时，单程网络出行时间呈现出具有统计学意义的空间自相关性，这表明与居住在佛罗里达州其他地区的家庭相比，居住在某些县集群中的家庭出行时间要长得多。
该分析表明，将出生缺陷登记处数据与医院出院数据相链接以研究医疗护理可及性的地理差异是有用的。地理信息系统方法在评估医疗护理的可及性和地理障碍方面很重要，可用于有特殊医疗需求的儿童，包括出生缺陷儿童。
