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Brief communication Timely access to secondary pediatric services: a key to reducing child and adolescent mortality
Miniku Kang1orcid , Young June Choe1orcid , Hye Sook Min2orcid , Saerom Kim3orcid , Seung-Ah Choe1orcid
Epidemiol Health 2024;e2024059
DOI: https://doi.org/10.4178/epih.e2024059 [Accepted]
Published online: July 5, 2024
1Korea University, Seoul, Korea
2National Medical Center, Seoul, Korea
3Seoul National University, Seoul, Korea
Corresponding author:  Seung-Ah Choe,
Email: seungah@korea.ac.kr
Received: 22 November 2023   • Revised: 14 February 2024   • Accepted: 25 March 2024
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Abstract

OBJECTIVES
Geographic disparities in access to secondary pediatric care remain a significant issue in countries with universal health coverage, including South Korea. Our study investigated the relationship between the geographic availability of secondary pediatric care services and mortality rates among children and adolescents in South Korea.
METHODS
We analyzed district-level data to assess the percentage of those aged 0-19 years residing outside of a 60-minute travel radius from the nearest secondary pediatric care provider (Accessibility Vulnerability Index, AVI). This analysis was conducted in conjunction with national mortality statistics for the same age group spanning the years 2017 to 2021. The concentration index was used to evaluate socioeconomic disparities in the AVI among districts. Using generalized estimating equation models, we calculated the relative risk (RR) of annual mortality per 10% increase in the AVI for secondary pediatric care.
RESULTS
The AVI ranged from 0% to 100% across the districts for the study period. The CI was -0.30 (95% CI, -0.41 to -0.19) in 2017 and -0.41 (95% CI, -0.52 to -0.30) in 2021, indicating that the proportion of those who could not access care within 60 minutes was disproportionately higher in districts with lower socioeconomic status. Our findings revealed an 8% rise in mortality rates among individuals aged 0-19 years for every 10% increase in AVI (95% CI, 1.06-1.10). The association between AVI and mortality was more pronounced during the COVID-19 pandemic (RR, 1.11; 95% CI, 1.08-1.14) than in the pre-pandemic period (RR< 1.07; 95% CI, 1.05-1.09; p for heterogeneity = 0.016).
CONCLUSIONS
Significant disparities were found in geographic access to pediatric care, which were relevant for child survival. Achieving true universal health coverage requires an emphasis on timely access to care for all pediatric populations.

Epidemiol Health : Epidemiology and Health
© Korean Society of Epidemiology.