Structural Factors and Racial/Ethnic Inequities in Travel Times to Acute Care Hospitals in the Rural US South, 2007-2018.
Structural Factors and Racial/Ethnic Inequities in Travel Times to Acute Care Hospitals in the Rural US South, 2007-2018.
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2007-2018 年美国南部农村地区急诊医院就诊时间的结构性因素和种族/民族不平等。
DOI：
10.1111/1468-0009.12655
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Ko,MichelleJ
中科院分区：
文献类型：
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作者：
Planey,ArriannaMarie;Planey,DonaldA;Wong,Sandy;McLafferty,SaraL;Ko,MichelleJ
政策要点政策制定者应投资于支持农村卫生系统的计划，更有针对性地关注空间可达性和种族和民族公平，而不仅仅是总供应或最近的设施措施。卫生计划网络充分性标准应解决最近和第二最近的医院护理的空间可及性，并纳入黑人和拉丁裔农村社区的公平标准。黑人和拉丁裔农村居民面临医院护理空间可及性的不平等，这是由于有色人种农村社区经济机会空间分配的基本结构性不平等造成的。需要包括赔偿在内的长期政策解决方案来解决这些根本过程。背景农村医院关闭率的不断上升引发了人们对医院护理机会减少的担忧。我们的研究目标如下：1）描述 2007 年至 2018 年间美国南部农村医院供应的变化，考虑卫生系统关闭、合并和转换； 2) 量化医院关闭后最有可能出现不良后果的人群（黑人和拉丁裔农村社区）的空间可达性（2018 年）； 3）使用多层次模型来检查结构因素和获得护理的空间可及性差异之间的关系。方法为了计算空间可及性，我们估计了2007年和2018年人口普查区级人口加权质心到最近和第二最近的运营医院之间的网络旅行距离和时间。此后，为了描述与2018年医院护理空间可及性相关的地方的人口和卫生系统特征，我们估计了三级（区域，研究结果我们发现，2007 年至 2018 年间，南方有 72 个（10%）农村县有 ≥1 家医院关闭，近一半的关闭县（33 个）因关闭而失去了最后一家医院。扣除关闭、合并和转换后的影响，医院供应量从 783 所下降到 653 所。总体而言，2007 年至 2018 年间，49.1% 的农村地区到最近医院的空间可达性恶化，而较小比例的农村地区在 2007 年至 2018 年间经历了改善（32.4%）或不变（18.5%）的可达性。与非封闭县的地区相比，位于关闭县内的地区到最近的急症护理医院的通行时间更长。此外，商业健康保险市场较为集中的南部各州农村地区前往第二个最近的医院的出行时间较短。 结论 受农村医院关闭影响的农村地区的急症护理出行负担更大。在整个南方农村地区，如果考虑到前往第二个最近的开放式急症护理医院的交通时间，在获得急症护理的空间方面的种族/族裔不平等最为明显。
Policy PointsPolicymakers should invest in programs to support rural health systems, with a more targeted focus on spatial accessibility and racial and ethnic equity, not only total supply or nearest facility measures.Health plan network adequacy standards should address spatial access to nearest and second nearest hospital care and incorporate equity standards for Black and Latinx rural communities.Black and Latinx rural residents contend with inequities in spatial access to hospital care, which arise from fundamental structural inequities in spatial allocation of economic opportunity in rural communities of color. Long‐term policy solutions including reparations are needed to address these underlying processes.ContextThe growing rate of rural hospital closures elicits concerns about declining access to hospital‐based care. Our research objectives were as follows: 1) characterize the change in rural hospital supply in the US South between 2007 and 2018, accounting for health system closures, mergers, and conversions; 2) quantify spatial accessibility (in 2018) for populations most at risk for adverse outcomes following hospital closure—Black and Latinx rural communities; and 3) use multilevel modeling to examine relationships between structural factors and disparities in spatial access to care.MethodsTo calculate spatial access, we estimated the network travel distance and time between the census tract–level population‐weighted centroids to the nearest and second nearest operating hospital in the years 2007 and 2018. Thereafter, to describe the demographic and health system characteristics of places in relation to spatial accessibility to hospital‐based care in 2018, we estimated three‐level (tract, county, state‐level) generalized linear models.FindingsWe found that 72 (10%) rural counties in the South had ≥1 hospital closure between 2007 and 2018, and nearly half of closure counties (33) lost their last remaining hospital to closure. Net of closures, mergers, and conversions meant hospital supply declined from 783 to 653. Overall, 49.1% of rural tracts experienced worsened spatial access to their nearest hospital, whereas smaller proportions experienced improved (32.4%) or unchanged (18.5%) access between 2007 and 2018. Tracts located within closure counties had longer travel times to the nearest acute care hospital compared with tracts in nonclosure counties. Moreover, rural tracts within Southern states with more concentrated commercial health insurance markets had shorter travel times to access the second nearest hospital.ConclusionsRural places affected by rural hospital closures have greater travel burdens for acute care. Across the rural South, racial/ethnic inequities in spatial access to acute care are most pronounced when travel times to the second nearest open acute care hospital are accounted for.