• Lauren E Brown, Urbano L França, and Michael L McManus.
• Division of Critical Care, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA.
• Pediatr Crit Care Me. 2021 Dec 1; 22 (12): 103310411033-1041.

ObjectivesTo describe the geography of pediatric critical care services and the relationship between poverty and distance to these services across the United States.DesignRetrospective, cross-sectional study.SettingContiguous United States.PatientsChildren less than 18 years as represented in the 2016 American Community Survey.InterventionsNone.Measurements And Main ResultsPediatric 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.ConclusionsIn the United States, the distance to pediatric critical care services increases with poverty. This carries implications for access to care and health outcome disparities.Copyright © 2021 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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