Disparities in spatial access to neurological care in Appalachia: a cross-sectional health services analysis.
Disparities in spatial access to neurological care in Appalachia: a cross-sectional health services analysis.
复制标题
DOI：
10.1016/j.lana.2022.100415
复制
发表时间：
2023-02
期刊：
影响因子：
--
通讯作者：
McGinley, Marisa P.
中科院分区：
文献类型：
--
作者：
Buchalter, R. Blake;Gentry, Erik G.;Willis, Mary A.;McGinley, Marisa P.
阿巴拉契亚是农村和社会经济剥夺与沉重的负担，神经系统疾病和穷人获得医疗保健提供者。随着时间的推移，神经系统疾病的发病率正在增加，而供应商的数量却没有相应的增加，这表明阿巴拉契亚地区的差异可能会恶化。美国地区尚未对神经护理的空间访问进行有力的探索，因此我们的目的是研究脆弱的阿巴拉契亚地区的差异。使用2022 CMS Care Compare医生数据，我们进行了一项横断面卫生服务分析，在该分析中，我们计算了13个州阿巴拉契亚县所有人口普查区域的神经科医生的空间可达性。我们分层访问率的国家，地区剥夺，城乡通勤区（RUCA）的代码，然后利用韦尔奇双样本t检验比较阿巴拉契亚地区与非阿巴拉契亚地区。使用分层结果，我们确定了阿巴拉契亚地区的干预措施将产生最大的影响。阿巴拉契亚神经束（n = 6169）的神经科医生空间访问率比非阿巴拉契亚神经束（n = 18,441; p < 0.001）低25%至35%。当按农村和贫困分层时，阿巴拉契亚地区的三步浮动集水区空间访问比率在大多数城市（RUCA = 1 [p < 0.0001]）和大多数农村地区（RUCA = 9 [p = 0.0093]; RUCA = 10 [p = 0.0227]）中仍然显着较低。我们确定了937个阿巴拉契亚人口普查区，可以有针对性地进行干预。分层后，农村地位和剥夺，显着的差距，在空间上获得神经科医生仍然为阿巴拉契亚地区，这表明在阿巴拉契亚较差的访问和神经科医生的可访问性不能仅仅由偏远和社会经济地位。这些发现和我们确定的差异领域对阿巴拉契亚的政策制定和干预目标具有广泛的影响。RB获得了T32 CA 094186号奖项的支持。M. P.M.得到了以下机构的支持-
Appalachia is rural and socioeconomically deprived with a heavy burden of neurological disorders and poor access to healthcare providers. Rates of neurological disorders are increasing over time without equal increases in providers, indicating that Appalachian disparities are likely to worsen. Spatial access to neurological care has not been robustly explored for U.S. areas, so we aimed to examine disparities in the vulnerable Appalachian region. Using 2022 CMS Care Compare physician data, we conducted a cross-sectional health services analysis, where we computed spatial accessibility of neurologists for all census tracts in the 13 states with Appalachian counties. We stratified access ratios by state, area deprivation, and rural-urban commuting area (RUCA) codes then utilized Welch two-sample t-tests to compare Appalachian tracts with non-Appalachian tracts. Using stratified results, we identified Appalachian areas where interventions would have the largest impact. Appalachian tracts (n = 6169) had neurologist spatial access ratios between 25% and 35% lower than non-Appalachian tracts (n = 18,441; p < 0.001). When stratified by rurality and deprivation, three-step floating catchment area spatial access ratios for Appalachian tracts remained significantly lower in the most urban (RUCA = 1 [p < 0.0001) and most rural tracts (RUCA = 9 [p = 0.0093]; RUCA = 10 [p = 0.0227]). We identified 937 Appalachian census tracts where interventions can be targeted. After stratifying by rural status and deprivation, significant disparities in spatial access to neurologists remained for Appalachian areas, indicating both poorer access in Appalachia and that neurologist accessibility cannot be determined solely by remoteness and socioeconomic status. These findings and our identified disparity areas have broad implications for policymaking and intervention targeting in Appalachia. R.B.B. was supported by Award Number T32CA094186. M.P.M. was supported by - Award Number KL2TR002547.
登录
查看更多内容
影响因子：
9.9
作者：
Dall, Timothy M.;Storm, Michael V.;Vidic, Thomas R.
通讯作者：
Vidic, Thomas R.
影响因子：
3
作者：
Donohoe J;Marshall V;Tan X;Camacho FT;Anderson R;Balkrishnan R
通讯作者：
Balkrishnan R
阿巴拉契亚农村地区吸烟的持续差异：山地空气项目的证据。
影响因子：
4.5
作者：
Cardarelli K;Westneat S;Dunfee M;May B;Schoenberg N;Browning S
通讯作者：
Browning S
衡量潜在的空间进入城市卫生服务的方法：距离类型和聚合 - 错误问题。
影响因子：
4.9
作者：
Apparicio P;Gelb J;Dubé AS;Kingham S;Gauvin L;Robitaille É
通讯作者：
Robitaille É
影响因子：
4.1
作者：
Grandner MA;Smith TE;Jackson N;Jackson T;Burgard S;Branas C
通讯作者：
Branas C