To describe the geography of pediatric critical care services and the relationship between poverty and distance to these services across the United States.
Retrospective, cross-sectional study.
Contiguous United States.
Children less than 18 years as represented in the 2016 American Community Survey.
MEASUREMENTS AND MAIN RESULTS:
Pediatric critical care services were geographically concentrated within urban areas, with half of all PICUs located within 9.5 miles of another (interquartile range, 3.4–51.5 miles). Median distances from neighborhoods to the nearest unit increased linearly with Area Deprivation Index (p < 0.001), such that the median distance from the least privileged neighborhoods was nearly three times that of the most privileged neighborhoods (first decile = 7.8 miles [interquartile range, 3.4–15.8 miles] vs tenth decile = 22.6 miles [interquartile range, 4.2–52.5 miles]; p < 0.001). A relationship between neighborhood poverty and distance to a PICU was present across all U.S. regions and within urban/suburban and rural areas.
In the United States, the distance to pediatric critical care services increases with poverty. This carries implications for access to care and health outcome disparities.