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Summary:

Kalamazoo County, Michigan is an urban-rural county with high rates of maternal risk factors and poor birth outcomes. Analysis of health outcomes in the county has primarily focused on densely populated areas of low socioeconomic status.  However, the county has high disparities in outcomes among various segments of its population.

 

Problem:

Women without appropriate access to healthcare during particular stages of pregnancy have poorer outcomes than women with regular access to care. This paper examines the disparities in transportation network accessibility by public transit and private vehicle across the urban-rural continuum. The research also broadly considers: What are best practices for using open source methods to quantify transportation accessibility? Can variability in accessibility be quantified in a meaningful way? How does multimodal transportation impact accessibility in an urban-rural environment? Can multimodal accessibility be used to better understand community structure?

Research Results:

Regarding best practices for using open source methods to quantify transportation accessibility, when as much variability as possible (departure time, routes, modes, time of day) was included in the model, very detailed community structure information emerged.  This structural information is not specifically causal, but differences in behaviors and use of services, as well as differences in urban poverty and rural poverty were apparent.Reported, confirmed cases of maternal risk factors (diabetes, hypertension) and infant outcomes (low birth weight, premature births and neonatal intensive care admits) for Kalamazoo County, were retrieved from 2012-14 Michigan birth records and georeferenced. Individuals in the urban core had the highest multimodal accessibility, because of general proximity to the one central public transit hub (Figure 1). While hospitals are centrally accessible. Infants born to mothers just outside the urban core had a higher rate of poor outcomes.  Maternal risk factors, by contrast, were associated with the accessible rural areas – areas outside the city proper, but within 30 minutes by car to services.

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Regarding best practices for using open source methods to quantify transportation accessibility, when as much variability as possible (departure time, routes, modes, time of day) was included in the model, very detailed community structure information emerged.  This structural information is not specifically causal, but differences in behaviors and use of services, as well as differences in urban poverty and rural poverty were apparent. 

 

Conclusion

Accessibility maps at the census block level were distributed to community stakeholders. In response, we performed an analysis of pilot data relating accessibility to inappropriate use of emergency services for pediatric patients. We also examined decision maker and policy implications of siting and/or limiting particular health services in particular areas. As a result of this, and other research, Kalamazoo County received a $5 million grant from the US Health Resources and Services Administration (HRSA) to develop and continue effective programming to reduce poor maternal and infant outcomes and disparities.  The work in this TRCLC project specifically enabled the principle investigator for argue for greater community coverage (outside the zip codes in the urban core) and this was approved by HRSA.

Presentation

Final Report