Differences in child opportunity index for pediatric patients who travel for subspecialty colorectal care: a pediatric colorectal and pelvic learning consortium (PCPLC) study

Purpose: The Child Opportunity Index (COI) measures neighborhood-level resources for children. Children with congenital colorectal conditions are managed at few specialty centers. We compared neighborhood opportunity and urbanicity between children who travel for this care and those who do not. Methods: Retrospective cohort study of Pediatric Colorectal and Pelvic Learning Consortium registry patients with a valid ZIP code, used to assign COI and urbanicity. Travel was residence at least 50 miles (straight-line) from the treating center. Groups were compared using Fisher's exact and Cochran-Armitage trend tests; no adjusted models were fitted. Results: Of 6258 patients, 3804 (60.8%) did not travel and 2454 (39.2%) traveled. Children who traveled were more often from low- or moderate-COI (48.6% vs. 36.5%) and rural (38.3% vs. 9.8%) neighborhoods; non-travelers were more often from very high-COI (28.2% vs. 18.3%) and, less markedly, very low-COI (12.6% vs. 10.2%) neighborhoods (all p < 0.001). Very low-COI neighborhoods accounted for 11.7% of the cohort versus approximately 20% nationally. Conclusion: Travel for specialty colorectal care is concentrated among children from lower-opportunity and rural neighborhoods. Because travel distance and rural residence are closely linked, and only children reaching a center are captured, these findings are descriptive and cannot quantify unmet need.