Unequal access: Geographic and demographic inequities in pediatric general surgical care in the United States

Objective: Access to specialized pediatric surgical care is crucial for optimal child health outcomes; however, geographic barriers may limit timely access. This study examines national variations in distance to pediatric general surgeons across the United States. Methods: We performed a cross-sectional analysis using 2020 American Pediatric Surgical Association membership data to identify board-certified pediatric surgeons, linked with population demographics from the 2020 U S. Census. Straight-line distances from each ZIP code to the nearest pediatric surgeon were calculated, both allowing and restricting crossing of state lines. Distances were compared across demographic, geographic, and socioeconomic factors. State-level surgeon-to-child ratios were standardized and analyzed. Results: Among 73,103,902 children and 1527 pediatric surgeons (47,874 children per surgeon), 89.2 % of children lived within 60 miles of a pediatric surgeon, while 10.8 % lived farther away. Median travel distance differed by race, with Native American children traveling the farthest (86.4 miles), followed by White (28.7), Black (16.9), and Asian (11.8) children. Rural and economically distressed areas were disproportionately affected, with 45.4 % and 18.8 %, respectively, living more than 60 miles from care. Restricting travel within state lines increased the proportion of children living more than 60 miles from a surgeon to 13.8 % and to 54.1 % in rural areas. State-level distances varied from 9.1 miles in Rhode Island to 360.7 miles in Alaska. Nineteen states had more pediatric surgeons than expected based on population, while 31 had fewer. Conclusions: Despite increased availability of pediatric surgeons, significant geographic and demographic disparities persist, highlighting the need for targeted policies to promote equitable pediatric surgical care nationwide.