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    Home»Neurology»Disparities in spatial access to neurological care in Appalachia: A cross-sectional health services analysis
    Neurology

    Disparities in spatial access to neurological care in Appalachia: A cross-sectional health services analysis

    brainwealthy_vws1exBy brainwealthy_vws1exDecember 20, 2022No Comments22 Mins Read
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    Introduction

    The Appalachian region of the U.S. has a heavy burden of neurological disorders, including stroke, brain/central nervous system cancer, and Alzheimer’s disease and related dementias.

    1

    • Ostrom Q.T.
    • Gittleman H.
    • Kruchko C.
    • Barnholtz-Sloan J.S.
    Primary brain and other central nervous system tumors in Appalachia: regional differences in incidence, mortality, and survival.

    , 

    2

    • Wing J.J.
    • Levine D.A.
    • Ramamurthy A.
    • Reider C.
    Alzheimer’s disease and related disorders prevalence differs by Appalachian residence in Ohio.

    , 

    3

    • Schwartz F.
    • Ruhil A.
    • Denham S.
    • Shubrook J.
    • Simpson C.
    • Boyd S.L.
    High self-reported prevalence of diabetes mellitus, heart disease, and stroke in 11 counties of rural Appalachian Ohio.

    , 

    4

    • Halverson J.A.
    • Barnett E.
    • Casper M.
    Geographic disparities in heart disease and stroke mortality among Black and White populations in the Appalachian region.

    Perhaps most notably, a substantial portion of southern Appalachia is included in the ‘stroke belt,’ which is a long-studied geographic phenomenon of particularly high rates of stroke incidence and mortality in the southeastern U.S.

    5

    • Casper M.L.
    • Wing S.
    • Anda R.F.
    • Knowles M.
    • Pollard R.A.
    The shifting stroke belt. Changes in the geographic pattern of stroke mortality in the United States, 1962 to 1988.

    Strokes are linked to other neurological disorders, including dementia and cognitive decline,

    6

    • Kuźma E.
    • Lourida I.
    • Moore S.F.
    • Levine D.A.
    • Ukoumunne O.C.
    • Llewellyn D.J.
    Stroke and dementia risk: a systematic review and meta-analysis.

    ,

    7

    Is the stroke belt worn from childhood?: current knowledge and future directions.

    so the high rates in the southeast and Appalachia may be particularly burdensome on population neurological health in these areas. Detrimental modifiable factors and clinical characteristics, such as poor diet, smoking, low levels of physical activity, obesity, hypertension, and insufficient sleep, are common in Appalachian populations and may be driving the noted burden of neurological disorders in the region.

    8

    • Grandner M.A.
    • Smith T.E.
    • Jackson N.
    • Jackson T.
    • Burgard S.
    • Branas C.
    Geographic distribution of insufficient sleep across the United States: a county-level hotspot analysis.

    , 

    9

    • Sabia S.
    • Fayosse A.
    • Dumurgier J.
    • et al.
    Association of sleep duration in middle and old age with incidence of dementia.

    , 

    10

    • Fang J.
    • Wheaton A.G.
    • Ayala C.
    Sleep duration and history of stroke among adults from the USA.

    , 

    11

    • Cardarelli K.
    • Westneat S.
    • Dunfee M.
    • May B.
    • Schoenberg N.
    • Browning S.
    Persistent disparities in smoking among rural Appalachians: evidence from the mountain air project.

    , 

    12

    • Lutfiyya M.N.
    • Chang L.F.
    • Lipsky M.S.
    A cross-sectional study of US rural adults’ consumption of fruits and vegetables: do they consume at least five servings daily?.

    , 

    13

    • Parks S.E.
    • Housemann R.A.
    • Brownson R.C.
    Differential correlates of physical activity in urban and rural adults of various socioeconomic backgrounds in the United States.

    , 

    14

    • Howard V.J.
    • McDonnell M.N.
    Physical activity in primary stroke prevention: just do it!.

    , 

    15

    Prevalence of self-reported hypertension and antihypertensive medication use by county and rural-urban classification—United States, 2017.

    , 

    16

    • Pugazhenthi S.
    • Qin L.
    • Reddy P.H.
    Common neurodegenerative pathways in obesity, diabetes, and Alzheimer’s disease.

    Rates of neurological disorders are also expected to increase over time in the U.S. without equal increase in providers, indicating a potential shortage of neurological care providers nationwide.

    17

    • Dall T.M.
    • Storm M.V.
    • Chakrabarti R.
    • et al.
    Supply and demand analysis of the current and future US neurology workforce.

    Any shortage of neurologists in Appalachia may further complicate efforts to reduce regional neurological disorder disparities. Within the last decade, telehealth has emerged as a new strategy to combat shortages of neurology providers in Appalachia, yet barriers persist due to insufficient access to internet/internet-connected devices and limited digital literacy, among others.

    18

    • Strowd R.E.
    • Strauss L.
    • Graham R.
    • et al.
    Rapid implementation of outpatient teleneurology in rural Appalachia: barriers and disparities.

    ,

    19

    • Saadi A.
    • Mendizabal A.
    • Mejia N.I.

    Overcoming these barriers via policymaking and public health campaigns will be critical for expanding Appalachian teleneurology capabilities.

    Due to factors unique to Appalachia, such as an abnormally high density of both rurality and low socioeconomic status,

    20

    Healthcare in Appalachia and the role of the Federal Government.

    ,

    21

    • Behringer B.
    • Friedell G.H.
    Appalachia: where place matters in health.

    residents of Appalachia not only have exceptional difficulty accessing primary and specialist care, but also have poorer health outcomes than other areas of the U.S.

    21

    • Behringer B.
    • Friedell G.H.
    Appalachia: where place matters in health.

    ,

    22

    Health status and access to health care services: a comparison between Ohio’s rural non-Appalachian and Appalachian families.

    Factors such as socioeconomic deprivation, hospital closures, lower supply of healthcare workers, topography, low education levels, adverse health beliefs, poor health literacy, and urbanization commonly are cited as factors contributing to healthcare access disparities in the region.

    20

    Healthcare in Appalachia and the role of the Federal Government.

    ,

    23

    • Lengerich E.J.
    • Tucker T.C.
    • Powell R.K.
    • et al.
    Cancer incidence in Kentucky, Pennsylvania, and West Virginia: disparities in Appalachia.

    Access disparities for both primary and specialist care have been repeatedly identified and linked to poorer health outcomes in Appalachia,

    21

    • Behringer B.
    • Friedell G.H.
    Appalachia: where place matters in health.

    ,

    22

    Health status and access to health care services: a comparison between Ohio’s rural non-Appalachian and Appalachian families.

    ,

    24

    • Donohoe J.
    • Marshall V.
    • Tan X.
    • Camacho F.T.
    • Anderson R.T.
    • Balkrishnan R.
    Spatial access to primary care providers in Appalachia: evaluating current methodology.

    ,

    25

    • Donohoe J.
    • Marshall V.
    • Tan X.
    • Camacho F.T.
    • Anderson R.
    • Balkrishnan R.
    Predicting late-stage breast cancer diagnosis and receipt of adjuvant therapy: applying current spatial access to care methods in appalachia (revised version).

    but literature exploring access to neurological care in the region is comparatively sparse.

    26

    • Lin C.C.
    • Callaghan B.C.
    • Burke J.F.
    • et al.
    Geographic variation in neurologist density and neurologic care in the United States.

    This is particularly true for examination of spatial access to care, which is a sub-category of healthcare accessibility specifically referring to the ability of a population in a given area to physically reach health services.

    27

    • Apparicio P.
    • Gelb J.
    • Dubé A.S.
    • Kingham S.
    • Gauvin L.
    • Robitaille É.
    The approaches to measuring the potential spatial access to urban health services revisited: distance types and aggregation-error issues.

    Spatial accessibility is an important piece of the broader access to care continuum, along with health insurance coverage, timeliness of care, and a capable healthcare workforce.

    28

    Agency for Healthcare Research and Quality
    Topic: access to care.

    Some studies have noted geographic variations and fluctuating densities of neurological care in the U.S.,

    17

    • Dall T.M.
    • Storm M.V.
    • Chakrabarti R.
    • et al.
    Supply and demand analysis of the current and future US neurology workforce.

    ,

    26

    • Lin C.C.
    • Callaghan B.C.
    • Burke J.F.
    • et al.
    Geographic variation in neurologist density and neurologic care in the United States.

    ,

    29

    • van der Goes D.N.
    • Ney J.P.
    • Garrison L.P.
    Determinants of specialist physician ambulatory visits: a neurology example.

    , 

    30

    Geographic variations in specialty distribution and specialty-related mortality.

    , 

    31

    • Minden S.L.
    • Hoaglin D.C.
    • Hadden L.
    • Frankel D.
    • Robbins T.
    • Perloff J.
    Access to and utilization of neurologists by people with multiple sclerosis.

    , 

    32

    • Seabury S.
    • Bognar K.
    • Xu Y.
    • Huber C.
    • Commerford S.R.
    • Tayama D.
    Regional disparities in the quality of stroke care.

    , 

    33

    • Kalkbrenner A.E.
    • Daniels J.L.
    • Emch M.
    • Morrissey J.
    • Poole C.
    • Chen J.C.
    Geographic access to health services and diagnosis with an autism spectrum disorder.

    , 

    34

    • Giacobbe A.
    • Au K.L.K.
    • Nguyen O.T.
    • et al.
    Geospatial analysis of persons with movement disorders living in underserved regions.

    but none have 1) integrated robust geographic access-specific measures to determine disparities in accessibility or 2) examined accessibility for small areas (e.g., census tracts). The Appalachian region is an ideal candidate for deeper study of neurological care spatial accessibility due to the high burden of neurological disease and the previously identified disparities in access to both primary and specialized care.

    In this study, we used a comprehensive physician location dataset to construct neurological care spatial accessibility measures for all census tracts in the 13 states with Appalachian counties. We aimed to compare neurologist spatial access in Appalachian census tracts to spatial access in non-Appalachian census tracts and to identify fine scale localities where intervention campaigns could be targeted. Our overarching objectives were to provide direct evidence of neurological care spatial accessibility disparities in the Appalachian region and to assist in pinpointing small areas where policies and interventions may have the largest impact.

    Results

    The 13-state study area had a total 2010 population of 101,525,560 with 25,446,136 (25.1%) residing in 6169 Appalachian census tracts and 76,079,424 (74.9%) in 18,441 non-Appalachian tracts. The study area contained 5669 neurologists at 12,722 practice locations, with 1123 neurologists (19.8%) at 2184 locations in Appalachian tracts and 4546 (80.2%) at 10,538 locations in non-Appalachian tracts. The neurologist dataset for the entire U.S. contained 15,852 active physicians, roughly matching estimates by the AMA and American Academy of Neurologists.

    53

    American Medical Association
    Physician specialty data report: active physicians with a U.S. Doctor of medicine (U.S. MD) degree by specialty, 2015.

    ,

    54

    American Academy of Neurology
    2020 Insights report.

    Neurologist SPAR averages in the 13-state study area of both Appalachian and non-Appalachian tracts closely matched the average of the entire nation (1.0), where the mean study area SPARs for 2SFCA, E2SFCA, and 3SFCA were 1.003, 1.102, and 1.035, respectively. In comparison to the maximum 2SFCA (2.553) and E2SFCA (2.883) SPARs, the maximum SPAR for 3SFCA was much higher (7.180), which is likely due to the 3SFCA spatial impedance function placing more emphasis on nearby physicians. SPARs for neurologists were significantly lower in Appalachian tracts compared with non-Appalachian tracts, with mean differences of −0.252 or −25.2% (p Fig. 1 shows the strong effect that the selected access method has on resulting measures, where integration of distance decay (panel B) and spatial impedance (panel C) substantially modulate SPARs, particularly in reducing the likely overestimation of access seen in the 2SFCA method (panel A).

    Figure thumbnail gr1

    Fig. 1Jenks natural breaks maps of two-step floating catchment area (A), enhanced two-step floating catchment area (B), and three-step floating catchment area (C) spatial access ratios for neurological care (N = 24,610). Red denotes areas with poorer spatial access to neurologists and blue denotes areas with better spatial access to neurologists. The bolded and outlined area is the boundary of Appalachia, as classified by the Appalachian Regional Commission.

    When classified into RUCA categories, exposure-response relationships were identified for all calculated neurologist SPARs, where SPARs decreased nearly continuously as tracts became more rural and remote (Table 1). SPARs for 2SFCA were less linear in their RUCA exposure-response relationships, while SPARs from the E2SFCA method and the 3SFCA method had stronger downward trends as tracts became more rural, which is likely due to their distance decay and impedance functions, respectively. Interestingly, exposure-response relationships were weaker for bivariate ADI-SPAR relationships, where upper quintiles of deprivation were similar to lower quintiles. Comparing SPARs between Appalachian and non-Appalachian tracts by state revealed that for a large majority of states, Appalachian tracts have significantly poorer spatial access to neurologists (Supplementary Table S1). In Alabama and Georgia, the opposite relationships were found, where non-Appalachian tracts had poorer access to neurologists. However, sensitivity analyses showed that SPARs in Alabama and Georgia were likely modulated by socioeconomic deprivation, as non-Appalachian tracts had higher deprivation than Appalachian tracts in these two states, which was not seen in the other 11 states in our analysis (Supplementary Table S2). ADI values and RUCA codes by census tract can be viewed for the study area in Supplementary Fig. S2.

    Table 1Census-tract level neurologist spatial access ratio descriptive statistics by rural urban commuting area codes and area deprivation quintile (n = 24,610 tracts).

    Comparison of SPARs between Appalachian and non-Appalachian census tracts by RUCA code revealed that even after stratifying by urban/rural status, significant disparities remained in spatial access to neurologists for both urban and rural Appalachian populations (Table 2). Specifically, tracts designated as metropolitan area cores, metropolitan area high commuting, small town core, small town high commuting, and rural Appalachian tracts had significantly lower SPARs than non-Appalachian areas. For 2SFCA and E2SFCA, Appalachian SPARs were also significantly lower than non-Appalachian SPARs in metropolitan area low commuting and micropolitan core designations, though significance did not hold for these designations in the 3SFCA method. Across three of the five ADI quintiles, Appalachian tracts had significantly lower SPARs than non-Appalachian tracts and a relatively consistent exposure-response relationship was identified, particularly for E2SFCA and 3SFCA (Supplementary Table S3). There were no Appalachian tracts and only a single non-Appalachian tract in the lowest deprivation quintile (Table 3). Also, in the RUCA code and ADI stratification, RUCA codes generally had a stronger effect on SPARs than ADI. Based on this, we mapped results from Table 2 to identify Appalachian tracts both in the lowest natural breaks category of 3SFCA SPARs (≤0.4022) and with the following RUCA codes: 1, 2, and 10 (Fig. 2). The 937 Appalachian tracts where interventions could be targeted contained a total population count of 3,754,508. ADI thresholds were not utilized to identify intervention target areas due to a lack of clear delineation between ADI categories in Table 3. Results from the sensitivity analyses can be found in the Supplementary Material.

    Table 2Census tract neurologist spatial access ratio averages by rural-urban commuting area codes and status as Appalachian (n = 6169) or non-Appalachian (n = 18,441) tract (total N = 24,610 tracts).

    Bold: Welch t-test significance <0.05.

    Table 3Census tract neurologist spatial access ratio averages by rural-urban commuting area codes, area deprivation, and status as Appalachian (n = 6169) or non-Appalachian (n = 18,441) tract (total N = 24,610 tracts).

    Bold: Welch t-test significance <0.05.

    Figure thumbnail gr2

    Fig. 2Appalachian census tract neurologist spatial accessibility intervention areas (N = 937). Intervention areas include those tracts existing in the lowest natural breaks category of three-step floating catchment area spatial access ratios (≤0.4022) and with the following 2010 rural-urban commuting area codes: 1, 2, and 10.

    Discussion

    We constructed neurologist spatial access measures for the 13 states with Appalachian counties and found considerable disparities in accessibility among Appalachian populations. Depending on the specific spatial access measure, Appalachian tracts had SPARs that were between 25% and 35% lower than non-Appalachian tracts. These broad figures were modulated by urban and rural status, as significant differences in geographic access between Appalachia and non-Appalachia only held in the most urban (RUCA = 1, 2) and rural (RUCA = 10) tracts after stratifying by both area deprivation and RUCA code. Though other studies have found that Appalachian populations have difficulty accessing primary and specialist care,

    22

    Health status and access to health care services: a comparison between Ohio’s rural non-Appalachian and Appalachian families.

    ,

    24

    • Donohoe J.
    • Marshall V.
    • Tan X.
    • Camacho F.T.
    • Anderson R.T.
    • Balkrishnan R.
    Spatial access to primary care providers in Appalachia: evaluating current methodology.

    ,

    25

    • Donohoe J.
    • Marshall V.
    • Tan X.
    • Camacho F.T.
    • Anderson R.
    • Balkrishnan R.
    Predicting late-stage breast cancer diagnosis and receipt of adjuvant therapy: applying current spatial access to care methods in appalachia (revised version).

    ,

    55

    • Lane N.M.
    • Lutz A.Y.
    • Baker K.
    • et al.
    Health care costs and access disparities in appalachia.

    this is the first examination of spatial access to neurological care for the Appalachian region. More broadly, though other studies have identified geographic variation in neurological care across the U.S.,

    17

    • Dall T.M.
    • Storm M.V.
    • Chakrabarti R.
    • et al.
    Supply and demand analysis of the current and future US neurology workforce.

    ,

    26

    • Lin C.C.
    • Callaghan B.C.
    • Burke J.F.
    • et al.
    Geographic variation in neurologist density and neurologic care in the United States.

    ,

    29

    • van der Goes D.N.
    • Ney J.P.
    • Garrison L.P.
    Determinants of specialist physician ambulatory visits: a neurology example.

    , 

    30

    Geographic variations in specialty distribution and specialty-related mortality.

    , 

    31

    • Minden S.L.
    • Hoaglin D.C.
    • Hadden L.
    • Frankel D.
    • Robbins T.
    • Perloff J.
    Access to and utilization of neurologists by people with multiple sclerosis.

    , 

    32

    • Seabury S.
    • Bognar K.
    • Xu Y.
    • Huber C.
    • Commerford S.R.
    • Tayama D.
    Regional disparities in the quality of stroke care.

    , 

    33

    • Kalkbrenner A.E.
    • Daniels J.L.
    • Emch M.
    • Morrissey J.
    • Poole C.
    • Chen J.C.
    Geographic access to health services and diagnosis with an autism spectrum disorder.

    this is also the first study to directly compute spatial access to neurologist measures for an entire U.S. region. We revealed that urban and rural status are more important drivers of neurologist spatial access than socioeconomic status, as ADI categories had weaker effects on SPARs than RUCA codes when stratifying by ADI and RUCA code. Furthermore, we found that in the most urban and rural areas, the differences in SPARs between Appalachian and non-Appalachian tracts were most stark, which suggests that neurologist access disparities are not only problematic in rural Appalachia, but also in Appalachian metropolitan areas. Though specialist physicians are more frequently located in urban areas,

    56

    • Bhavaraju N.
    • Nanni J.
    • Carlson C.
    • Sholk J.
    • Peterson K.
    • Smith L.
    Breaking the barriers to specialty care.

    our analysis indicates that Appalachian urban areas, such as Knoxville, TN; Greenville, SC; and Charlestown, WV have substantially poorer spatial access to neurologists than non-Appalachian metro areas. Though there is a lack of direct empirical work as to why neurologist access may be lower specifically in urban Appalachia, potential reasons include difficulty recruiting specialty physicians due to limited budgets of state funding-dependent hospital/academic departments and higher numbers of uninsured patients, as six of the thirteen Appalachian states have opted out of Medicaid expansion. Lower health insurance coverage combined with cultural attitudes in Appalachia may be resulting in a potential cascade effect of reduced specialist care-seeking behavior, lower demand for specialist services, and correspondingly, fewer specialist services and physicians.

    57

    Health insurance and access to health care in the United States.

    , 

    58

    The demand for health insurance and health care: a review of the empirical literature.

    , 

    59

    • Starcher R.W.
    • Geurin L.
    • Shannon L.
    • Whitley A.
    Assessing the likelihood of seeking health care in rural Kentucky: applying the barriers to help seeking scale to Appalachian and non-Appalachian undergraduates.

    Medicaid expansion in Alabama, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee may improve urban access to care in these Appalachian states. Beyond tabulating access disparities, our mapping results provide actionable, fine-scale disparity target areas, where policies and intervention campaigns can be directed for highest impact. These maps have the potential to be broadly useful to policymakers, public health practitioners, and clinicians. Overall, our results suggest that basic measures of socioeconomic deprivation and rurality are insufficient to describe access to neurological care.

    Several intervention strategies and policies have been proposed to improve access to neurological care, including expansion of telemedicine, adjustments to physician visa waiver and loan forgiveness programs, and quick response mobile units for treatment of acute conditions. Recent literature suggests that teleneurology is broadly beneficial for care access across the spectrum of acute and chronic neurological disorders, including stroke, traumatic brain injury, epilepsy, movement disorders, and general neurology.

    60

    • Hatcher-Martin J.M.
    • Adams J.L.
    • Anderson E.R.
    • et al.
    Telemedicine in neurology: telemedicine work group of the American Academy of Neurology update.

    The importance and effectiveness of teleneurology in Appalachia specifically is also beginning to be understood,

    18

    • Strowd R.E.
    • Strauss L.
    • Graham R.
    • et al.
    Rapid implementation of outpatient teleneurology in rural Appalachia: barriers and disparities.

    yet barriers persist, especially among the most marginalized Appalachian groups: older individuals, the non-Hispanic Black population, and those on government insurance. The ‘digital divide’ is well-documented in the Appalachian region,

    61

    As telemedicine expands successfully, disparities persist: lessons from Appalachia. NeurologyToday.

    , 

    62

    Bridging the digital divide in rural appalachia: internet usage in the mountains. Unpublished Ph D Informing Science Carbondale, USA: Southern Illinois University.

    , 

    63

    • Black D.A.
    • Mather M.
    • Sanders S.G.
    Standards of living in Appalachia, 1960–2000.

    and the disparities seem to translate to teleneurology, where lack of internet, smartphones, and computers have been cited as barriers to care.

    18

    • Strowd R.E.
    • Strauss L.
    • Graham R.
    • et al.
    Rapid implementation of outpatient teleneurology in rural Appalachia: barriers and disparities.

    Policies to increase access to these technologies among marginalized Appalachian populations, such as the recent infrastructure law passed by the U.S. congress,

    64

    US infrastructure plan will narrow digital divide.

    may help ease barriers identified. Other policy solutions could increase the supply of neurologists serving Appalachia: 1) the recent revision of Conrad 30 ARC J-1 visa waiver policies to include foreign specialist physicians in addition to foreign primary care providers and 2) expansion of domestic medical graduate loan forgiveness programs to include Appalachian specialist physicians.

    65

    • Pathman D.E.
    • Konrad T.R.
    • King T.S.
    • Taylor Jr., D.H.
    • Koch G.G.
    Outcomes of states’ scholarship, loan repayment, and related programs for physicians.

    ,

    66

    • DeBolt C.L.
    • Brizendine C.
    • Tomann M.M.
    • Harris D.A.
    Lung disease in central Appalachia: it’s more than coal dust that drives disparities.

    ARC J-1 visa waiver policies were changed in 2019 to include specialist physicians,

    67

    Conrad 30 waiver program 2019-2022 guidelines.

    (p30) but the effects are not yet clear. Domestic medical graduate loan repayment/forgiveness programs for Appalachia are typically reserved for primary care providers and targeted specifically to healthcare shortage areas.

    68

    HRSA
    NHSC Rural Community Loan Repayment Program.

    , 

    69

    HRSA
    NHSC State Loan Repayment Program (SLRP).

    , 

    70

    Rural Health Information Hub
    Funding by type: loan repayment programs.

    As shown in our analysis, neurologist access does not necessarily follow broader physician access/shortage patterns, which further indicates the utility of specialty-specific spatial access measures in formulating loan forgiveness policy. Another recent advancement to address access to neurological care is the proliferation of quick response mobile units to treat acute conditions, commonly known as mobile stroke units (MSUs).

    71

    • Parker S.A.
    • Bowry R.
    • Wu T.C.
    • et al.
    Establishing the first mobile stroke unit in the United States.

    MSUs contain imaging equipment, laboratory systems, and hospital telemedicine linkage to provide care at the site of emergency.

    72

    • Schwindling L.
    • Ragoschke-Schumm A.
    • Kettner M.
    • et al.
    Prehospital imaging-based triage of head trauma with a mobile stroke unit: first evidence and literature review.

    Mobile units have potential to improve treatment timeliness of stroke and other acute neurological conditions in areas with poor access to physical neurologist offices. These solutions could be directed to the disparity target areas we identified in Fig. 2. These intervention areas could be further refined for subspecialties within neurology and incorporate other important factors (e.g., broadband internet) that would impact the delivery of the specific intervention. Beyond adjustments in health policy, hospital, and physician-related factors, patient-level educational and intervention campaigns could be directed to disparity areas to reduce the burden of neurological disorders on the Appalachian region. For example, potential avenues include educational campaigns to improve knowledge of stroke symptoms or intervention campaigns targeting primary prevention of adverse health behaviors.

    This study had several strengths, including use of robust SPAR measures, use of comprehensive physician location data, and stratification of spatial access by rurality and ADI. The E2SFCA and 3SFCA SPARs utilized are not only advanced spatial statistics-based representations of access to care,

    24

    • Donohoe J.
    • Marshall V.
    • Tan X.
    • Camacho F.T.
    • Anderson R.T.
    • Balkrishnan R.
    Spatial access to primary care providers in Appalachia: evaluating current methodology.

    ,

    45

    • Wan N.
    • Zou B.
    • Sternberg T.
    A three-step floating catchment area method for analyzing spatial access to health services.

    ,

    73

    • McCrum M.L.
    • Wan N.
    • Lizotte S.
    • Han J.
    • Varghese T.
    • Nirula R.
    Use of the spatial access ratio to measure geospatial access to emergency general surgery services in California.

    but are also novel in the context of our application towards neurologist access. In terms of physician locations, the CMS Care Compare data had high coverage of active physicians, where roughly 97% of neurologists are estimated to be captured by the database.

    74

    • Ochieng N.
    • Schwartz K.
    • Neuman T.
    How many physicians have opted-out of the Medicare program? Kaiser Family Foundation.

    Another strength was stratification of our access measures by rurality and ADI, which allowed for more granular examination of where and why access disparities exist. This study also had several limitations, including possible over- or under-estimation of the physician population, inability to fully explore areas of lowest deprivation, use of 2010 distance matrix and population data, use of a Euclidean distance matrix, and the possibility that poor spatial access to neurologists was simply measuring poorer overall access to physicians. CMS Care Compare physician data may also have over- or underestimated the number and/or density of neurologists in the study area. Because the data are estimated to capture roughly 97% of neurologists,

    74

    • Ochieng N.
    • Schwartz K.
    • Neuman T.
    How many physicians have opted-out of the Medicare program? Kaiser Family Foundation.

    a slight undercount is possible. Other ‘comprehensive’ physician datasets by the AMA and CMS face similar issues with cataloging of physicians,

    75

    • DesRoches C.M.
    • Barrett K.A.
    • Harvey B.E.
    • et al.
    The results are only as good as the sample: assessing three national physician sampling frames.

    indicating a lack of better options in addition to the noted high coverage of Care Compare. Also, we included all physician practice locations, as no variable exists in Care Compare by which to restrict to primary practice location, which could have overestimated physician density in certain areas. We used nationwide quintiles for better representation of the true area socioeconomic deprivation of the study area. Only a single tract in the study area existed in the lowest socioeconomic deprivation quintile, which resulted in NAs in our tabulated ADI results. However, using study area-specific quantiles would have underestimated the widespread socioeconomic deprivation in Appalachia, indicating that nation-based ADI quantiles were optimal. We used 2010 distance matrix and population data due to availability and accuracy. In a supplementary analysis of 2010–2019 population change, we found that there was little concern for differential misclassification (Supplementary Materials). Euclidean distance matrices tend to overestimate access to care, particularly for urban areas, as they do not account for the complexity of road networks and other transit modalities, such as urban rail. Although we acknowledge that it would be ideal to account for complex transportation matrices, this requires exponentially more computational and memory requirements, which was not feasible for a census tract-level analysis. Future work may consider using advanced routing methods to build more representative travel matrices. In addition, for 82 or 0.33% of census tracts in the study area, RUCA codes were unavailable. For the 82 missing values, 78 were non-Appalachian tracts, 4 were Appalachian, and overall SPARs were close to 1 for each of the FCA methods. Due to only a small proportion of missing values, significant differential effects due to missingness were exceedingly unlikely. Finally, our supplementary construction of a geographic access measure for primary care providers displayed that our neurologist SPARs were not simply identifying areas with poor overall spatial access to providers (Supplementary Fig. S3). Though there was moderate to strong Spearman correlation between neurologist and primary care provider SPARs, visual inspection showed substantial differences. For example, SPARs for primary care providers in Appalachian metro areas, such as Knoxville, TN and Charleston, WV were substantially higher than SPARs for neurologists in the same areas, revealing the utility of directly studying spatial access to neurologists.

    This study demonstrated the significant disparities in geographic access to neurological care in the Appalachian region. Our geographic access measures highlight that access to neurologists cannot be solely defined by rural/urban location or socioeconomic status. Future intervention studies attempting to address disparities in neurological care access should consider incorporating spatial access measures to target areas of greatest need.



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