Spatial and Temporal Trends of Access to Birthing Hospitals in Illinois, 2016-2021.

INTRODUCTION: Changes in the availability of birthing hospitals may affect geographic access to obstetric care. Travel time to the nearest birthing hospital is a measurable indicator of access. We estimated changes in travel time in Illinois from 2016 to 2021 and described the distribution of populations living in census tracts with increased travel time. METHODS: We used Illinois Department of Public Health hospital data (2016-2021), US Census population-weighted block group (PWBG) centroids, and American Community Survey data (2017-2021). We estimated driving time from PWBG centroids to the nearest in-state birthing hospital (driving time) by using ArcGIS network analysis and averaging to census tracts. We assessed changes overall and by rural-urban classification, race and ethnicity, and educational attainment. RESULTS: The number of Illinois birthing hospitals decreased 16.9%, from 118 in 2016 to 98 in 2021. Average driving time increased from 12.1 to 13.2 minutes overall, from 9.5 to 10.4 minutes in urban areas, and from 24.1 to 25.9 minutes in rural areas. Overall, 18.3% of Illinois residents (2,288,738 of 12,502,452) lived in census tracts with increased driving time. Among residents living in rural areas, 23.7% lived in affected tracts, compared with 17.4% among those living in urban areas. Among non-Hispanic White residents in Illinois, 14.9% lived in affected tracts, compared with 32.1% of non-Hispanic Black residents. Among college graduates, 14.8% lived in affected tracts, compared with 23.3% of residents with less than a high school education. CONCLUSION: From 2016 to 2021, changes in the availability of birthing hospitals in Illinois coincided with modest increases in driving time and were not evenly distributed across populations. These findings provide a descriptive assessment of geographic access to obstetric care and may inform efforts to address differences in access.