Social Disadvantage and Transportation Insecurity in Clubfoot Clinic.

Abstract

This study aims to evaluate the association of missing clubfoot clinic visits with transportation barriers and measures of socioeconomic status including the child opportunity index (COI). An 11-question survey was administered to caregivers of patients with clubfoot seen at a single pediatric tertiary hospital between August 2020 and September 2023. A chart review was conducted to obtain zip codes used to determine COI 2.0 scores. The impact of race/ethnicity, income, persons per household, COI, and transportation methods on missing at least one clinic visit was analyzed using descriptive and nonparametric statistics. The transportation survey was completed by a total of 99 caregivers. The median travel time to the clinic was 45 minutes (IQR: 33, range: 1 to 180). Most participants reported use of a personal car (108/128, 83%), and 72% took time off work to attend the appointment. Those with lower COI had longer travel time ( P =0.02) and were less likely to use personal cars ( P =0.05). Missed clubfoot clinic visits were more common for families reliant on transportation other than a personal vehicle ( P =0.01) and those with annual income under $30,000 ( P =0.02). Transportation insecurity was associated with greater social disadvantage as indicated by COI and more missed clinic visits. Level III.