P3.P312: Social Disadvantage and Transportation Insecurity in Clubfoot Clinic

Background: Social determinants of health impact health outcomes1,2. Studies in low- and middle-income countries have identified limited access to transportation as a barrier in clubfoot care, however little is known in the United States regarding transportation as barrier to clubfoot care3. The purpose of this study is to evaluate the association of missing clubfoot clinic visits with transportation barriers and measures of socioeconomic status including the Child Opportunity Index (COI).

Methods: 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 which were used to determine COI 2.0 scores. Using descriptive and non-parametric statistics, the impact of socioeconomic factors, COI, and transportation methods on missing at least one clinic visit was analyzed.

Results: 129 caregivers completed the survey. The median travel time to the clinic was 45 minutes (IQR 33, range 1-180). 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), were less likely to use personal car (p=0.05) and trended towards more often taking time off work for visits (p=0.16). Missing an appointment due to transportation issues was not related to COI (p=0.58) or distance or time from the hospital (p>0.67) but was more common in those who did not have a personal vehicle (33% vs. 8%, p=0.009) and those with income below $30,000 (22% vs. 5%, p=0.03).

Conclusion: Those with lower COI had longer travel time, were less likely to use a personal car, and were more likely to take time off work for visits, but this did not result in missing more appointments due to issues with transportation. To improve access to care by understanding the barriers related to transportation and social determinants of health, this study provides useful information in identifying transportation barriers in this population.