@Article{chd.12819,
AUTHOR = {Katherine B. Salciccioli, Abiodun Oluyomi, Philip J. Lupo, Peter R. Ermis, Keila N. Lopez},
TITLE = {A model for geographic and sociodemographic access to care disparities for adults with congenital heart disease},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {5},
PAGES = {752--759},
URL = {http://www.techscience.com/schd/v14n5/38856},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> 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.<br/>
<b>Objective:</b> 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.<br/>
<b>Methods:</b> 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.<br/>
<b>Results:</b> 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 <1 hour drive, those living 
>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).<br/>
<b>Conclusions:</b> 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.},
DOI = {10.1111/chd.12819}
}