PDF(Pubmed)
Abstract：
BACKGROUND: Birthing people in the United States face numerous challenges when accessing adequate prenatal care (PNC), with transportation being a significant obstacle. Nevertheless, previous studies that relied solely on the distance to the nearest provider cannot differentiate the effects of travel burden on provider selection and care utilization. These may exaggerate the degree of inequality in access and fail to capture perceived travel burden. This study investigated whether travel distances to the initially visited provider, to the predominant PNC provider, and perceived travel burden (measured by the travel disadvantage index (TDI)) are associated with PNC utilization.
METHODS: A retrospective cohort of people with live births were identified from South Carolina Medicaid claims files in 2015-2018. Travel distances were calculated using Google Maps. The estimated TDI was derived from local pilot survey data. PNC utilization was measured by PNC initiation and frequency. Repeated measure logistic regression test was utilized for categorical variables and one-way repeated measures ANOVA for continuous variables. Unadjusted and adjusted ordinal logistic regressions with repeated measure were utilized to examine the association of travel burdens with PNC usage.
RESULTS: For 25,801 pregnancies among those continuously enrolled in Medicaid, birthing people traveled an average of 24.9 and 24.2 miles to their initial and predominant provider, respectively, with an average TDI of -11.4 (SD, 8.5). Of these pregnancies, 60% initiated PNC in the first trimester, with an average of 8 total visits. Compared to the specialties of initial providers, predominant providers were more likely to be OBGYN-related specialists (81.6% vs. 87.9%, p < .001) and midwives (3.5% vs. 4.3%, p < .001). Multiple regression analysis revealed that every doubling of travel distance was associated with less likelihood to initiate timely PNC (OR: 0.95, p < .001) and a lower visit frequency (OR: 0.85, p < .001), and every doubling of TDI was associated with less likelihood to initiate timely PNC (OR: 0.94, p = .04).
CONCLUSIONS: Findings suggest that the association between travel burden and PNC utilization was statistically significant but of limited practical significance.
METHODS: A retrospective cohort of people with live births were identified from South Carolina Medicaid claims files in 2015-2018. Travel distances were calculated using Google Maps. The estimated TDI was derived from local pilot survey data. PNC utilization was measured by PNC initiation and frequency. Repeated measure logistic regression test was utilized for categorical variables and one-way repeated measures ANOVA for continuous variables. Unadjusted and adjusted ordinal logistic regressions with repeated measure were utilized to examine the association of travel burdens with PNC usage.
RESULTS: For 25,801 pregnancies among those continuously enrolled in Medicaid, birthing people traveled an average of 24.9 and 24.2 miles to their initial and predominant provider, respectively, with an average TDI of -11.4 (SD, 8.5). Of these pregnancies, 60% initiated PNC in the first trimester, with an average of 8 total visits. Compared to the specialties of initial providers, predominant providers were more likely to be OBGYN-related specialists (81.6% vs. 87.9%, p < .001) and midwives (3.5% vs. 4.3%, p < .001). Multiple regression analysis revealed that every doubling of travel distance was associated with less likelihood to initiate timely PNC (OR: 0.95, p < .001) and a lower visit frequency (OR: 0.85, p < .001), and every doubling of TDI was associated with less likelihood to initiate timely PNC (OR: 0.94, p = .04).
CONCLUSIONS: Findings suggest that the association between travel burden and PNC utilization was statistically significant but of limited practical significance.
摘要：
背景：在美国出生的人在获得适当的产前护理（PNC）时面临许多挑战，交通是一个重大障碍。然而，以前的研究仅依赖于与最近提供者的距离,无法区分旅行负担对提供者选择和护理利用的影响.这些可能会夸大获取方面的不平等程度，并且无法抓住感知的旅行负担。这项研究调查了到最初拜访的提供者的旅行距离是否，对主要的PNC提供商来说，和感知的旅行负担(由旅行劣势指数(TDI)衡量)与PNC利用率相关。
方法：从2015-2018年的南卡罗来纳州医疗补助索赔文件中确定了一个回顾性的活产者队列。使用Google地图计算旅行距离。估计的TDI来自当地试点调查数据。通过PNC起始和频率测量PNC利用率。分类变量采用重复测量逻辑回归检验，连续变量采用单向重复测量方差分析。使用重复测量的未调整和调整的序数逻辑回归来检查旅行负担与PNC使用的关联。
结果：对于连续参加医疗补助的人中的25,801例怀孕，出生的人平均旅行24.9英里和24.2英里到他们的初始和主要提供者，分别,平均TDI为-11.4(SD，8.5).在这些怀孕中，60%的人在孕早期开始PNC，平均共访问8次。与初始提供者的专长相比，主要提供者更有可能是OBGYN相关专家(81.6%与87.9%,p<.001）和助产士（3.5%vs.4.3%,p<.001)。多元回归分析显示，旅行距离的每加倍与启动及时PNC的可能性较小（OR：0.95，p<.001）和较低的访问频率（OR：0.85，p<.001）相关。TDI的每加倍与启动及时PNC的可能性较小相关(OR:0.94,p=.04)。
结论：研究结果表明，旅行负担与PNC利用率之间的关联具有统计学意义，但实际意义有限。
方法：从2015-2018年的南卡罗来纳州医疗补助索赔文件中确定了一个回顾性的活产者队列。使用Google地图计算旅行距离。估计的TDI来自当地试点调查数据。通过PNC起始和频率测量PNC利用率。分类变量采用重复测量逻辑回归检验，连续变量采用单向重复测量方差分析。使用重复测量的未调整和调整的序数逻辑回归来检查旅行负担与PNC使用的关联。
结果：对于连续参加医疗补助的人中的25,801例怀孕，出生的人平均旅行24.9英里和24.2英里到他们的初始和主要提供者，分别,平均TDI为-11.4(SD，8.5).在这些怀孕中，60%的人在孕早期开始PNC，平均共访问8次。与初始提供者的专长相比，主要提供者更有可能是OBGYN相关专家(81.6%与87.9%,p<.001）和助产士（3.5%vs.4.3%,p<.001)。多元回归分析显示，旅行距离的每加倍与启动及时PNC的可能性较小（OR：0.95，p<.001）和较低的访问频率（OR：0.85，p<.001）相关。TDI的每加倍与启动及时PNC的可能性较小相关(OR:0.94,p=.04)。
结论：研究结果表明，旅行负担与PNC利用率之间的关联具有统计学意义，但实际意义有限。
