Social Disadvantage and Transportation Insecurity in Clubfoot Clinic

Objectives: This study aims 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 used to determine COI 2.0 scores. The impact of race/ethnicity, income, persons per household, COI, and transportation methods on missing at least one clinic visit was analyzed using descriptive and nonparametric statistics.

Results: The transportation survey was completed by a total of 99 caregivers. The median travel time to the clinic was 45 minutes (IQR: 33, range: 1 to 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) and were less likely to use personal cars ( P =0.05). Missed clubfoot clinic visits were more common for families reliant on transportation other than a personal vehicle ( P =0.01) and those with annual income under $30,000 ( P =0.02).

Conclusions: Transportation insecurity was associated with greater social disadvantage as indicated by COI and more missed clinic visits.

Level of evidence: Level III.