2023 American Academy of Neurology Abstract Website

Objective:

To examine neurological care spatial access disparities among various demographic segments of the U.S. population.

Background:

Incidence of neurological conditions in the U.S. is rising. A shortage of neurology clinicians and poorly understood disparities may hinder access to neurological care. There is a critical need to define community characteristics that may contribute to care access.

Design/Methods:

Neurologist practice locations from 2022 CMS Care Compare physician data were used to compute spatial access to neurological care measures for all U.S. census tracts. Census tract-level community characteristics (sex, age, race, ethnicity, education, income, insurance, % with computer, % without a vehicle, % with limited English % with hearing, vision, cognitive and ambulatory difficulty) were obtained from 2020 American Community Survey 5-year estimates. Rural-urban status was obtained from 2010 rural-urban commuting areas codes. Generalized additive models were built using 60-mile enhanced two-step floating catchment area spatial access ratios and three-step floating catchment area spatial access ratios as outcomes and community characteristics as predictors.

Results:

Using results from 73,057 U.S. census tracts, we found that access to neurological care (% change in ratio of neurologists to individuals) was significantly lower for rural (-80.8%) and micropolitan (-61.1%) areas. Additionally, tracts with a higher percentage of Hispanic populations (-0.5%), males (-0.9%), public insurance (-0.3%), uninsured (-0.9%), individuals with hearing difficulty (-5.2%), vision difficulty (-1.2%), and ambulatory difficulty (-1.9%) (p<0.001) had lower access. Urban census tracts and tracts with greater Black (0.3%) and older (0.8%) populations were found to have higher spatial access to neurologists

Conclusions:

Access to neurological care appears worse in rural regions and in regions with higher proportions of Hispanics, and individuals with disabilities. For urban and Black communities proximity to neurologists is less likely a significant contributor to poor access. To improve neurological care disparities, future interventions will need to target unique access drivers for specific populations.