Association between neurodevelopmental disorders and travel distance for dental caries treatment under general anesthesia among Japanese pediatric patients: a single-center retrospective cross-sectional study

Dental caries remains a global public health challenge, and dental treatment under general anesthesia (DGA) is often necessary in uncooperative pediatric patients. Although Japan has a well-established universal healthcare system, DGA provision is limited and concentrated in urban areas. Children with neurodevelopmental disorders (NDDs) may need to travel farther to receive DGA for dental caries, particularly in Hokkaido, which is characterized by a vast geographic area and high rurality index. This study aimed to examine whether NDDs were associated with longer travel distance among children receiving DGA for dental caries. We conducted a single-center retrospective cross-sectional study of pediatric participants (age: ≤12 years) who underwent DGA for dental caries between 2015 and 2020. The primary outcome was the distance (km) from their residence to the treatment facility. The secondary outcome was a travel distance of ≥ 16 km, and the sensitivity outcome was crossing the secondary healthcare service area boundaries. Multivariable linear regression was used for the primary outcome, and modified Poisson regression was used for the secondary and sensitivity outcomes. A false discovery rate adjustment was applied to secondary and sensitivity analyses. Among the 398 eligible participants (median age, 4.0 years; 57.5% male), 16.3% had NDDs, most commonly autism spectrum disorder and intellectual developmental disorders. The mean travel distance was 11.9 km (standard deviation [SD]: 25.3); 11.1% of the participants resided ≥ 16 km away, and 3.0% crossed secondary healthcare service area boundaries. The multivariable analysis showed that participants with NDDs resided 12.0 km farther from the treatment facility than those without NDDs (95% confidence interval [CI]: 4.6 to 19.0, p = 0.001). In the secondary and sensitivity analyses, the direction of association was similar, although the findings did not reach FDR-adjusted significance, with travel distance of ≥ 16 km away and crossing secondary healthcare service area boundaries. Among children who received DGA for dental caries, those with NDDs travelled farther than those without NDDs, despite the well-established universal healthcare system in Japan. These findings suggest geographic travel burden may differ according to NDD status.