OBJECTIVES: We analyze drive times to pediatric inpatient and intensive care services in the U.S. according to Child Opportunity Index (COI), racial/ethnic composition, and urbanicity. STUDY DESIGN: Geospatial information system analyses delineated drive-time catchments of 0-30, 31-60, 61-120 and 120-240minutes around hospitals with ≥5 inpatient pediatric and pediatric intensive care unit(PICU) beds. For each catchment, population-weighted COI, percent pediatric population of underrepresented races/ethnicities (%UR), and urbanicity were calculated and compared between the four drive-time catchments and for >
60 versus ≤60-minute drive-times. Prevalence ratios (PR) were calculated for >
60 versus ≤60-minute drive-times to compare the prevalence of longer drive-times for catchments with lower COI and lower %UR (versus higher), and rural versus urban areas. RESULTS: Overall, 8.1% and 20.5% of children reside >
60-minutes from pediatric and PICU services. Catchments within 60-minutes of inpatient or PICU services had higher COI (4.8, [95%CI 3.2, 6.5] and 6.1 [7.7, 4.5] respectively) compared with those >
60-minutes. Very low quintile COI catchments (versus very high) were more likely to be >
60-minutes from pediatric inpatient care (PR 2.89 [2.30, 3.61]) and PICU (PR 2.48 [1.92, 3.20]). %UR was 2.7% higher in <
60-minute drive-time catchments (95%CI 0.1, 5.23, p=0.043) versus those >
60-minutes. Greater prevalence of >
60-minute drive-times was seen in catchments with a lower %UR (versus higher) and for rural (versus urban) catchments for pediatric and PICU services. CONCLUSIONS: Children living further from pediatric care tend to have less resources and reside in rural areas. These data inform public health solutions for equitable resource distribution as care consolidates.