Spatial inequalities in preventive breast cancer care: A comparison of different accessibility approaches for prevention facilities in Bavaria, Germany

Abstract

BackgroundAccessibility analysis is a essential method for depict spatial inequalities. Healthcare services should be accessible to everyone in a timely manner and available in sufficient number. The main objective is to analyze the equivalence of access to preventive breast cancer care facilities in Bavaria, Germany. MethodsAccessibility is understood as a multidimensional concept, which is applied by different accessibility methods (Nearest facility and 2-step flow and catchment area analysis (2SFCA)) and two means of transportation. For both methodological approaches, we compare the results for individual and public transport. We use high-resolution population-based data to provide small-scale comparisons. ResultsThe access for women over 50 years varies widely. In particularly large differences were found between accessibility by car and public transport, especially in rural regions. The results also differ within urban and rural regions, in some cases strongly, depending on the share of vulnerable population groups and the infrastructural situation. The comparison of the 2SFCA indices show that the supply situation depends not only on the proximity to the population and adequate supply capacities, but also on their connection to the transport system. In the case of public transport, it was shown that within the estimated operating distances, it usually provides better supply, especially in the urban area. ConclusionsWe were able to reveal spatial inequalities in access to preventive breast cancer care facilities in Bavaria for women over 50 years. By identifying underserved regions and especially discriminate between public and individual transportation, more precise actions to overcome inequalities in accessibility for single regions and resident groups can be drawn. Especially, policy-makers and other stakeholders rely on comprehensive information to (likely) initiate interventions to reduce spatial inequalities to health care facilities. Based on demographics, trends in outpatient planning and the findings of this paper, inequality is expected to increase.