Associations of rurality, child opportunity, and distance with use of pediatric asthma specialists.

Abstract

Receipt of asthma specialty care reduces asthma morbidity in children, but children living in rural, socioeconomically disadvantaged, and remote areas face potential barriers to accessing specialists. We sought to evaluate the associations of rurality, Child Opportunity Index (COI), and distance with pediatric asthma specialist utilization among children with an indication for specialist referral. In this retrospective cohort study using 2015-2021 Maine Health Data Organization All-Payer Claims Data, we identified children (<18 years old) with asthma and one of the following indications for specialist referral: a complicating comorbidity, higher-level controller medications, 3 or more courses of systemic corticosteroids within a year, or a respiratory hospitalization. We performed multivariate logistic regressions to calculate the adjusted associations between utilization of pediatric asthma specialists (physicians or advanced practice providers specializing in allergy/immunology or pediatric pulmonology) in the year after indication and children's rurality, COI, and driving time to specialists. Among 12,014 children with indications for pediatric asthma specialist referral, 47% lived in micropolitan or rural areas, and 15% lived more than 1 hour from any specialist. A total of 2,296 children (19%) received care from specialists within a year of their indication. In adjusted analyses, children were significantly less likely to see specialists if they lived in small towns (adjusted odds ratio [aOR] 0.54, 95% CI 1.09-1.39) or isolated small rural areas (aOR 0.82, 95% CI 0.71-0.94), areas with a COI less than "very high" (for "very low," aOR 0.65, 95% CI 0.56-0.75), or farther from specialists (aOR 0.62 per hour, 95% CI 0.57-0.68). Children in rural areas, in areas of low socioeconomic opportunity, and far from specialists are at an increased risk of not receiving indicated asthma specialist care.