2-step Floating Catchment Area Research Articles

Abstract 800: Spatial accessibility of gynecologic oncologists and time to surgery in a diverse cohort of women with ovarian cancer in Northern California

Abstract Introduction: To expand our understanding of factors contributing to racial and ethnic disparities in ovarian cancer outcomes, we examined the association between spatial accessibility of gynecologic oncologists and time from cancer diagnosis to surgery in the KPROCS Study, a diverse cohort of women diagnosed with ovarian cancer between 2000-2018 at Kaiser Permanente Northern California (KPNC). Spatial medical accessibility is a component of healthcare access that captures the proximity and availability of healthcare resources in the area. Methods: Ovarian cancer cases were identified through the KPNC Cancer Registry. Demographic and clinical information was extracted from KPNC databases. Neighborhood characteristics from the California Neighborhoods Data System were linked to the residential addresses of cases at the time of diagnosis. Spatial medical accessibility was measured using the 2-step floating catchment area method based on the location of the infusion centers where KPNC gynecologic oncologists practice and the residence location of cohort members. We used generalized estimating equations with independent correlation structure and robust standard errors to examine the association between spatial accessibility of gynecologic oncologists and time to ovarian cancer surgery, adjusting for year and age at diagnosis, stage, histotype, race, ethnicity, neighborhood socioeconomic status (nSES), and receipt of neoadjuvant chemotherapy. Results: The cohort comprised 4,910 women with ovarian cancer, of whom 3,304 had surgery at KPNC. Of this group, 13% were Hispanic, 14% were non-Hispanic (NH) Asian American women, 5% NH Black women, and 67% NH White women. The proportion of women residing in areas of the lowest spatial accessibility of gynecologic oncologists was highest among NH White women (26%) and women residing in the highest quintile of nSES (29%). The median time from diagnosis to surgery was 4 days (interquartile range 22 days). In adjusted analyses, not including the information on spatial accessibility, the time from diagnosis to surgery was 5.1 days longer (95% CI 1.5, 8.7) for NH Black women than NH White women. After adding information on spatial accessibility, this time did not considerably change, resulting in a 5.3-day (95% CI 1.7, 8.9) difference. In this model, the lowest quintile of spatial accessibility of gynecologic oncologists was associated with a longer time from diagnosis to surgery, but this association was not statistically significant (0.4 days difference, 95% CI -1.3, 2.0). Summary: In our preliminary analyses, spatial accessibility of gynecologic oncologists was not found to be a contributing factor to the disparity in time from diagnosis to surgery between NH Black and NH White women. Further analyses will examine time from diagnosis to chemotherapy overall and stratified by racial and ethnic groups. Citation Format: Ekaterina Chirikova, Pushkar P. Inamdar, Valerie McGuire, Salma Shariff-Marco, Valerie S. Lee, Lindsay J. Collin, Carola T. Sanchez-Diaz, Juraj Kavecansky, C Bethan Powell, Jennifer A. Doherty, Lawrence H. Kushi, Elisa V. Bandera, Scarlett L. Gomez. Spatial accessibility of gynecologic oncologists and time to surgery in a diverse cohort of women with ovarian cancer in Northern California [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 800.

Enhancing Health Care Accessibility and Equity Through a Geoprocessing Toolbox for Spatial Accessibility Analysis: Development and Case Study.

Access to health care services is a critical determinant of population health and well-being. Measuring spatial accessibility to health services is essential for understanding health care distribution and addressing potential inequities. In this study, we developed a geoprocessing toolbox including Python script tools for the ArcGIS Pro environment to measure the spatial accessibility of health services using both classic and enhanced versions of the 2-step floating catchment area method. Each of our tools incorporated both distance buffers and travel time catchments to calculate accessibility scores based on users' choices. Additionally, we developed a separate tool to create travel time catchments that is compatible with both locally available network data sets and ArcGIS Online data sources. We conducted a case study focusing on the accessibility of hemodialysis services in the state of Tennessee using the 4 versions of the accessibility tools. Notably, the calculation of the target population considered age as a significant nonspatial factor influencing hemodialysis service accessibility. Weighted populations were calculated using end-stage renal disease incidence rates in different age groups. The implemented tools are made accessible through ArcGIS Online for free use by the research community. The case study revealed disparities in the accessibility of hemodialysis services, with urban areas demonstrating higher scores compared to rural and suburban regions. These geoprocessing tools can serve as valuable decision-support resources for health care providers, organizations, and policy makers to improve equitable access to health care services. This comprehensive approach to measuring spatial accessibility can empower health care stakeholders to address health care distribution challenges effectively.

Exploring the provision, efficiency and improvements of urban green spaces on accessibility at the metropolitan scale

Accurately assessing urban green space (UGS) accessibility and proposing effective and specific proposals for UGS provision improvement accordingly is vital to urban development. Taking the metropolitan of Shanghai, China as the study site, this study first assessed its UGS provision by improved multiple step floating catchment area methods and multiple indexes, including UGS accessibility, theoretical capacity, potential demand, and traffic supply. Second, it investigated the impacts on citywide UGS accessibility justice for each UGS by comparing Gini index differences of citywide UGS accessibility between the conditions when exist and non-exist for each UGS. Third, it used ternary plots to explore the influence mechanism of the factors of UGS theoretical capacity, potential demand, and traffic supply on accessibility, and introduced an RGB color triangle to spatially and simultaneously display the effects of these three factors on accessibility for each UGS in Shanghai. Fourth, it assessed and classified the UGS provision efficiency for accessibility according to the relationships among the theoretical capacity, potential demand, and traffic supply factors by 3D scatter plot. Fifth, it proposed specific types and priorities of requirement for UGS improvement according to its impact on citywide UGS accessibility justice and the effect of its theoretical capacity factor on UGS accessibility. The findings showed that UGS accessibility and its three factors in Shanghai were correlative and had a spatial clustering trend in central city areas. The majority of UGSs showed positive impact on citywide accessibility justice, which went up with the values of accessibility and the three factors. Most UGSs were dominated by theoretical capacity power. The UGS provision efficiency was relatively good for most UGSs, which had relatively well-matched conditions and demands. The improvement requirements for UGSs on accessibility investigated in this study will improve UGS provision.

Access to community pharmacies based on drive time and by rurality across the contiguous United States

BackgroundConsidering that mail-order pharmacy use remains low in the United States, geographic accessibility of community pharmacies (pharmacy access) can have an outsized impact on a community’s access to services and care, especially among rural residents. However, previous measurements of pharmacy access rely on methods that do not capture all aspects of geographic access. ObjectivesThis study aimed to measure pharmacy access across the contiguous United States and by rural, suburban, and urban areas using drive-time analysis and an improved methodological approach. MethodsThe 2-step floating catchment area method was used to measure pharmacy access by considering the supply capacity of pharmacies, population demand for pharmacies, and the interaction between them within a reasonable travel time range. This method is a methodologically improved approach compared with previous methods for measuring geographic access. Network analysis was used to measure drive time from the population-weighted centroids of census tracts to the geocoded location of community pharmacies. Census tract-level pharmacy access was measured using a 10- and 20-minute drive time. Census tracts were also categorized based on population per square mile as rural (< 1000), suburban (1000-3000), and urban (> 3000). ResultsAcross the contiguous United States, 79.9% and 91.1% of census tracts had access to at least 1 pharmacy per 10,000 people within a 10- and 20-minute drive time, respectively. Rural census tracts had the lowest share of access to at least 1 pharmacy per 10,000 people compared with suburban and urban tracts and for both drive times. ConclusionCommunity pharmacies are highly accessible health care access points, specifically in urban and suburban areas. Pharmacies should be considered to expand access to services with limited geographic accessibility such as treatment programs for opioid use disorders, primary care, and healthy foods.

INEQUITY ANALYSIS IN THE LOW AND HIGH COMPLEXITY PUBLIC SERVICES SUPPLY IN RELATION TO BEDS AVAILABILITY IN MANIZALES - VILLAMARÍA CONURBATION

This research aims to determine the current conditions of geographical accessibility to and from healthcare centres in Manizales and Villamaría conurbation through the Enhanced two- step floating catchment area (E2SFCA) method, supported by geographic tools and socioeconomic assessments. The main result is that the average number of beds per 1000 inhabitants in low complexity systems is below the average defined for Colombia and Latin America, thus requiring greater attention in implementing beds to reach the required accessibility levels. These valuations allow concluding that the accessibility of healthcare institutions requires the use of significant calculation tools, such as the E2SFCA method, which has not had great applications within the Colombian territory.

Primary Health Care Accessibility in Zomba, Malawi: A Spatial Modelling Approach

Abstract. Access to primary health care (PHC), as the first point of care, is an essential factor in influencing the health status of a society. In Malawi, an individual is considered to have access to health care if they are within an 8 km radius to a health facility. Based on this, the Health Sector Strategic Plan (HSSP) II, 2017–2022 puts access to PHC in Malawi at 90 %. However, a Demographic Health Survey (DHS) reports that 56 % of women find distance as a major barrier. As such the aim of the study was to model spatial access to health of households in the district. The study used the 2 Step Floating Catchment Area (2FCSA) with Gaussian decay function method to model health care access and the greedy algorithm to find optimal locations for new facilities. The study found that 62% households have the potential of walking 60 minutes to the facility, a figure 28 % lower than the one reported by HSSP. With 2SFCA scores ranging from 0 to 0.19, the results show that 98 % and 57 % of the households scored between 0.031 to 0.046 for urban and rural areas respectively. These scores imply that urban households have better spatial accessibility than rural households. The results provide a spatially objective PHC accessibility data to inform policy direction.

The social equity and the spatial accessibility of general hospitals in big Chinese cities: an exploration based on different income groups and transportation modes in Shenzhen

Abstract Objectives: The rational planning and allocation of hospitals significantly improve residents’ health and quality of life. However, the unequal allocation of medical resources remains a significant issue in large Chinese cities. This study investigated the disparities in access to health care among different social groups in Shenzhen and explored the discrepancy in equity and its influencing mechanisms. Methods: The population was divided into 5 social groups based on housing prices: high-income, middle-high income, middle-income, middle-low income, and low-income. The actual travel times of residential neighborhoods and general hospitals under both driving and public transportation were accessed through the application programming interface Amap, a mapping technology application. The accessibility of general hospitals was calculated by the Gaussian-based 2-step floating catchment area method. The Gini coefficient was used to further investigate the equity in medical facility services. Results: Accessibility to first and second-level hospitals was adequate for the high-income group. However, a significant spatial mismatch in the allocation of hospitals was identified for the middle-low income and low-income groups, especially those reliant on public transportation. Conclusions: This study reveals an inequitable allocation of hospitals, with driving accessibility generally superior to public transport accessibility in Shenzhen, and a significant spatial mismatch for middle-low income and low-income groups. This study suggests optimizing public transportation around hospitals and middle-low income or low-income neighborhoods through urban planning to improve the accessibility of public service facilities for middle-low income and low-income households, thereby promoting more health equity.

Asian American Enclaves and Healthcare Accessibility: An Ecologic Study Across Five States

Access to primary care has been a long-standing priority for improving population health. Asian Americans, who often settle in ethnic enclaves, have been found to underutilize health care. Understanding geographic primary care accessibility within Asian American enclaves can help to ensure the long-term health of this fast-growing population. U.S. Census data from five states (California, Florida, New Jersey, New York, and Texas) were used to develop and describe census-tract level measures of Asian American enclaves and social and built environment characteristics for years 2000 and 2010. The 2-step floating catchment area method was applied to National Provider Identifier data to develop a tract-level measure of geographic primary care accessibility. Analyses were conducted in 2022-2023, and associations between enclaves (versus nonenclaves) and geographic primary care accessibility were evaluated using multivariable Poisson regression with robust variance estimation, adjusting for potential area-level confounders. Of 24,482 census tracts, 26.1% were classified as Asian American enclaves. Asian American enclaves were more likely to be metropolitan and have less poverty, lower crime, and lower proportions of uninsured individuals than nonenclaves. Asian American enclaves had higher primary care accessibility than nonenclaves (adjusted prevalence ratio=1.23, 95% CI=1.17, 1.29). Asian American enclaves in five of the most diverse and populous states in the U.S. had fewer markers of disadvantage and greater geographic primary care accessibility. This study contributes to the growing body of research elucidating the constellation of social and built environment features within Asian American enclaves and provides evidence of health-promoting characteristics of these neighborhoods.

Geographic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018.

Background Little is known about geographic variation in acute myocardial infarction (AMI) mortality within fast-developing megacities and whether changes in health care accessibility correspond to changes in AMI mortality at the small-area level. Methods and Results We included data of 94 106 AMI deaths during 2007 to 2018 from the Beijing Cardiovascular Disease Surveillance System in this ecological study. We estimated AMI mortality for 307 townships during consecutive 3-year periods with a Bayesian spatial model. Township-level health care accessibility was measured using an enhanced 2-step floating catchment area method. Linear regression models were used to examine the association between health care accessibility and AMI mortality. During 2007 to 2018, median AMI mortality in townships declined from 86.3 (95% CI, 34.2-173.8) to 49.4 (95% CI, 30.5-73.7) per 100 000 population. The decrease in AMI mortality was larger in townships where health care accessibility increased more rapidly. Geographic inequality, defined as the ratio of the 90th to 10th percentile of mortality in townships, increased from 3.4 to 3.8. In total, 86.3% (265/307) of townships had an increase in health care accessibility. Each 10% increase in health care accessibility was associated with a -0.71% (95% CI, -1.08% to -0.33%) change in AMI mortality. Conclusions Geographic disparities in AMI mortality among Beijing townships are large and increasing. A relative increase in township-level health care accessibility is associated with a relative decrease in AMI mortality. Targeted improvement of health care accessibility in areas with high AMI mortality may help reduce AMI burden and improve its geographic inequality in megacities.

Location selection of field hospitals amid COVID-19 considering effectiveness and fairness: A case study of Florida

The world has experienced an unprecedented global health crisis since 2020, the COVID-19 pandemic, which inflicted massive burdens on countries' healthcare systems. During the peaks of the pandemic, the shortages of intensive care unit (ICU) beds illustrated a critical vulnerability in the fight. Many individuals suffering the effects of COVID-19 had difficulty accessing ICU beds due to insufficient capacity. Unfortunately, it has been observed that many hospitals do not have enough ICU beds, and the ones with ICU capacity might not be accessible to all population strata. To remedy this going forward, field hospitals could be established to provide additional capacity in helping emergency health situations such as pandemics; however, location selection is a crucial decision ultimately for this purpose. As such, we consider finding new field hospital locations to serve the demand within certain travel-time thresholds, while accounting for the presence of vulnerable populations. A multi-objective mathematical model is proposed in this paper that maximizes the minimum accessibility and minimizes the travel time by integrating the Enhanced 2-Step Floating Catchment Area (E2SFCA) method and travel-time-constrained capacitated p-median model. This is performed to decide on the locations of field hospitals, while a sensitivity analysis addresses hospital capacity, demand level, and the number of field hospital locations. Four counties in Florida are selected to implement the proposed approach. Findings can be used to identify the ideal location(s) of capacity expansions concerning the fair distribution of field hospitals in terms of accessibility with a specific focus on vulnerable strata of the population.

Spatial access to buprenorphine-waivered prescribers in the HEALing communities study: Enhanced 2-step floating catchment area analyses in Massachusetts, Ohio, and Kentucky

IntroductionThe opioid overdose epidemic continues to impact a large swath of the population in the US. Medications for opioid use disorders (MOUD) are an effective resource to combat the epidemic; however, there is limited research on MOUD treatment access that accounts for both supply of and demand for services. We aimed to examine access to buprenorphine prescribers in the HEALing Communities Study (HCS) Wave 2 communities in Massachusetts, Ohio, and Kentucky during 2021, and the association between buprenorphine access and opioid-related incidents, specifically fatal overdoses and opioid-related responses by emergency medical services (EMS). MethodsWe calculated Enhanced 2-Step Floating Catchment Area (E2SFCA) accessibility indices for each state, as well as Wave 2 communities in each state, based on the location of providers (buprenorphine-waivered clinicians from the US Drug Enforcement Agency Active Registrants database), population-weighted centroids at the census block group level, and catchment areas defined by the state or community's average commute time. In advance of intervention initiation, we quantified the opioid-related risk environment of communities. We assessed gaps in services by using bivariate Local Moran's I analysis, incorporating accessibility indices and opioid-related incident data. ResultsMassachusetts Wave 2 HCS communities had the highest rates of buprenorphine prescribers per 1000 patients (median: 165.8) compared to Kentucky (38.8) and Ohio (40.1). While urban centers in all three states had higher E2SFCA index scores compared to rural communities, we observed that suburban communities often had limited access. Through bivariate Local Moran's I analysis, we identified numerous locations with low buprenorphine access surrounded by high opioid-related incidents, particularly in communities that surrounded Boston, Massachusetts; Columbus, Ohio; and Louisville, Kentucky. ConclusionRural communities demonstrated a great need for additional access to buprenorphine prescribers. However, policymakers should also direct attention toward suburban communities that have experienced significant increases in opioid-related incidents.

Refining 2SVCA method for measuring telehealth accessibility of primary care physicians in Baton Rouge, Louisiana

Equity in health care delivery is a longstanding concern of public health policy. Telehealth is considered an important way to level the playing field by broadening health services access and improving quality of care and health outcomes. This study refines the recently developed “2-Step Virtual Catchment Area (2SVCA) method” to assess the telehealth accessibility of primary care in the Baton Rouge Metropolitan Statistical Area, Louisiana. The result is compared to that of spatial accessibility via physical visits to care providers based on the popular 2-Step Floating Catchment Area (2SFCA) method. The study shows that both spatial and telehealth accessibilities decline from urban to low-density and then rural areas. Moreover, disproportionally higher percentages of African Americans are in areas with higher spatial accessibility scores; but such an advantage is not realized in telehealth accessibility. In the study area, absence of broadband availability is mainly a rural problem and leads to a lower average telehealth accessibility than physical accessibility in rural areas. On the other side, lack of broadband affordability is a challenge across the rural-urban continuum and is disproportionally associated with high concentrations of disadvantaged population groups such as households under the poverty level and Blacks.

Rural and frontier access to mental health prescribers and nonprescribers: A geospatial analysis in Oregon Medicaid.

Medicaid enrollees in rural and frontier areas face inadequate access to mental health services, but the extent to which access varies for different provider types is unknown. We assessed access to Medicaid-participating prescribing and nonprescribing mental health clinicians, focusing on Oregon, which has a substantial rural population. Using 2018 Medicaid claims data, we identified enrollees aged 18-64 with psychiatric diagnoses and specialty mental health providers who billed Medicaid at least once during the study period. We measured both 30- and 60-minute drive time to a mental health provider, and a spatial access score derived from the enhanced 2-step floating catchment area (E2SFCA) approach at the level of Zip Code Tabulation Areas (ZCTAs). Results were stratified for prescribers and nonprescribers, across urban, rural, and frontier areas. Overall, a majority of ZCTAs (68.6%) had at least 1 mental health prescriber and nonprescriber within a 30-minute drive. E2SFCA measures demonstrated that while frontier ZCTAs had the lowest access to prescribers (84.3% in the lowest quintile of access) compared to other regions, some frontier ZCTAs had relatively high access to nonprescribers (34.3% in the third and fourth quartiles of access). Some frontier areas with relatively poor access to Medicaid-participating mental health prescribers demonstrated relatively high access to nonprescribers, suggesting reliance on nonprescribing clinicians for mental health care delivery amid rural workforce constraints. Efforts to monitor network adequacy should consider differential access to different provider types, and incorporate methods, such as E2SFCA, to better account for service demand and supply.

Evaluation of Supply–Demand Matching of Public Health Resources Based on Ga2SFCA: A Case Study of the Central Urban Area of Tianjin

Determining whether the supply–demand matching (SDM) of urban public health resources is reasonable involves important issues such as health security and the rational use of resources. Using the central urban area of Tianjin as the research area, this paper used the Gaussian-based 2-step floating catchment area method (Ga2SFCA), combined with multi-source data, and comprehensively considered public medical, natural, and physical resources to evaluate the SDM of single-category and integrated public health resources in the research area. The results showed the following: (1) there was a good fit between supply and demand for public medical and natural health resources in Tianjin’s central urban area. For public physical health resources, there was a poor fit between supply and demand; the population in the supply insufficient and scarce areas for 82.78% of the total and was mainly distributed in the marginal areas of the four districts around the city and the six districts of the inner city. (2) For integrated public health resources, the degree of SDM was generally good. It had a circular structure that gradually shrank from the core to the edge. In order to promote the supply–demand balance of urban public health resources, this paper proposed three strategies involving three aspects: the supply, accessibility, and demand of urban public health resources. These strategies involve the service supply level, urban traffic network and slow traffic, development intensity, and population scale.

Spatial Accessibility of Primary Care in the Dual Public-Private Health System in Rural Areas, Malaysia.

Disparities in access to health services in rural areas represent a global health issue. Various external factors contribute to these disparities and each root requires specific remedial action to alleviate the issue. This study elucidates an approach to assessing the spatial accessibility of primary care, considering Malaysia's dual public-private system specifically in rural areas, and identifies its associated ecological factors. Spatial accessibility was calculated using the Enhance 2-Step Floating Catchment Area (E2SFCA) method, modified as per local context. Data were secondary sourced from Population and Housing Census data and administrative datasets pertaining to health facilities and road network. The spatial pattern of the E2SFCA scores were depicted using Hot spot Analysis. Hierarchical multiple linear regression and geographical weight regression were performed to identify factors that affect E2SFCA scores. Hot spot areas revolved near the urban agglomeration, largely contributed by the private sector. Distance to urban areas, road density, population density dependency ratios and ethnic composition were among the associated factors. Accurate conceptualization and comprehensive assessment of accessibility are crucial for evidence-based decision making by the policymakers and health authorities in identifying areas that need attention for a more specific and localized planning and development.

A composite X-minute city cycling accessibility metric and its role in assessing spatial and socioeconomic inequalities – A case study in Utrecht, the Netherlands

The 15 min city (or “X-minute city” in general) concept aims to give people access to all essential services and daily needs (e.g., healthcare, education, etc.) within X minutes of active transportation, to improve transport equity, sustainability, and traffic safety. To date, there is a lack of methods and tools to assess to what degree cities currently, or after implementing policies, comply with the X-minute city concept. This research aims to develop a methodology for quantifying the X-minute city through a metric (CSx) that was developed based on an accessibility framework and tested for cycling mode in the Utrecht region in the Netherlands as a study area. Travel data from the Netherlands mobility panel were analysed to determine input characteristics of the metric, such as the weight of destination types. Standardized gravity-based 2-step floating catchment area (2SFCA) accessibility scores for all destination types were weighted and aggregated into a composite metric that shows relative scores as an X-minute city. The results of the analysis show that 100% of the population in the Utrecht region has access to at least one destination for all 9 destination types within 15 min, whereas this number reduces to 94% within a 10 min cycling threshold; indicating the status of Utrecht as a cycling city with cycling-friendly infrastructure. Furthermore, low-income groups do not have lower cycling accessibility to the services in the 15 min city in the study area, reinforcing the notion that cycling can be an effective solution to reduce transport inequalities. The developed metric can be used to assess cities on their way towards becoming X-minute city, prioritise neighbourhoods to develop, set quantifiable goals, and evaluate planning scenarios.

Social Vulnerabilities and Spatial Access to Primary Healthcare through Car and Public Transportation System in the Albuquerque, NM, Metropolitan Area: Assessing Disparities through GIS and Multilevel Modeling.

Primary healthcare (PHC) is a keystone component of population health. However, inequities in public transportation access hinder equitable usage of PHC services by minoritized populations. Using the multimodal enhanced 2-step floating catchment area method and data in 2018 and 2019 for spatial access to PHC providers (n = 1166) and social vulnerability markers through census block (n = 543) and tract data (n = 226), a generalized linear mixed-effect model (GLMEM) was constructed to test the effects of sociodemographic and community area correlates on both car and bus transit spatial access to PHCin the Albuquerque, New Mexico (NM) metropolitan area. Results for bus spatial access to PHC showed lower access for Hispanics (B = - 0.097 ± 0.029 [- 0.154, - 0.040]) and non-Hispanic Whites (B = - 0.106 ± 0.032 [- 0.169, - 0.043]) and a positive association between single-family households and bus spatial access (B = 1.573 ± 0.349 [0.866, 2.261]). Greater disability vulnerability (B = - 0.569 ± 0.173 [- 0.919, - 0.259]) and language vulnerability (B = - 0.569 ± 0.173 [- 0.919, - 0.259]) were associated with decreased bus spatial access. For car spatial access to PHC, greater SES vulnerability (B = - 0.338 ± 0.021 [- 1.568, -0.143]), disability (B = - 0.721 ± .092 [- 0.862, - 0.50 9]), and language vulnerability (B = - 0.686 ± 0.172 [- 1.044, - 0.362]) were associated with less car spatial access. Results indicate a disproportionate burden of low PHC access among disadvantaged population groups who rely heavily on public transportation. These results necessitate targeted interventions to reduce these disparities in access to PHC.

Use of an E2SFCA method to assess healthcare resources in Jordan during COVID-19 pandemic

Healthcare spatial accessibility requires a better understanding and evaluation, especially during pandemic outbreaks like the recent COVID-19 pandemic. The main goal of this study is to measure and assess community-level spatial accessibility in Amman city to various COVID-19 related healthcare resources that could provide any urgent medical care for suspected or confirmed COVID-19 cases. To address this aim, the Enhanced 2-step floating catchment area (E2SFCA) method combined with several geospatial techniques were performed. The main E2SFCA results show the differences in the capacities and spatial accessibility of health facilities within Amman city, as well as how the variations are captured at different regions. The resulted spatial accessibility scores were presented in interactive Geo-spatial maps, analyzed, and compared for several health resources in public, private, and educational hospitals. The current research findings stated that although there are enough healthcare facilities to service almost the entire city, inappropriate health facility distribution, rather than a lack of resources, has resulted in coverage gaps in some areas. The center zones had been fully serviced, or perhaps over-served, by a large number of facilities. The other zones, on the contrary, were partially served or were even underserved by a certain number of resources.

Patient Accessibility to Eye Care in the United States

The United States (US) federal government uses health provider shortage areas (HPSAs) to define patient accessibility to primary care physicians. It is unclear whether HPSAs can be applied to eye care providers (ECPs). Our study determined the applicability of federal HPSA designations to ECP availability in the US. Cross-sectional study. US general population and ophthalmologists/optometrists in the Medicare database. The primary care HPSA score, visual impairment prevalence, and ECP location were determined for each census tract or county using data from the US Department of Health and Human Services, the Centers for Disease Control and Prevention, and Centers for Medicare and Medicaid Services. Association of HPSA with vision loss and ECP density was examined. The 2-step floating catchment area approach was used to newly define eye care shortage areas (patient accessibility score [PAS], higher being worse accessibility) for every county in the US, by weighting the 2-step FCA scores by prevalence of vision loss and ECP density. Multivariable logistic regression was used to identify sociodemographic variables associated with areas of ECP shortage. Among 72 735 census tracts included, statistically significant but weak correlations of HPSA scorewith visual impairment (VI) (r= 0.38; P < 0.0001) and ECP density per county population (r= -0.18; P < 0.0001) werefound. Only 54.0% of census tracts with < 25th percentile ECP density per county were HPSAs (P < 0.0001). Of census tracts > than 75th percentile for VI only 58.0% were HPSAs (P < 0.0001). Multivariable regression found a higher odds of ECP PAS ≥ 75th percentile (worseaccessibility) in rural counties (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.93-3.67; P< 0.001) and counties with a greater prevalence of residents with less than a high school education (aOR, 1.21; 95% CI, 1.19-1.25; P < 0.001), residents ≥ 65 years of age (aOR, 1.10; 95% CI, 1.07-1.13; P < 0.001), and uninsured residents (aOR, 1.04; 95% CI, 1.01-1.06; P < 0.001). Counties with a greater proportion of men (aOR, 0.93; 95% CI, 0.89-0.967; P < 0.001) or White residents (aOR, 0.99; 95% CI, 0.98-0.99) had a lower odds of ECP PAS ≥ 75th percentile. Current HPSAs only weakly correlate with ECP supply. We propose a new approach to identify counties with high need but limited access to eye care. Proprietary or commercial disclosure may be found after the references.

Impact of traffic congestion on spatial access to healthcare services in Nairobi.

Geographic accessibility is an important determinant of healthcare utilization and is critical for achievement of universal health coverage. Despite the high disease burden and severe traffic congestion in many African cities, few studies have assessed how traffic congestion impacts geographical access to healthcare facilities and to health professionals in these settings. In this study, we assessed the impact of traffic congestion on access to healthcare facilities, and to the healthcare professionals across the healthcare facilities. Using data on health facilities obtained from the Ministry of Health in Kenya, we mapped 944 primary, 94 secondary and four tertiary healthcare facilities in Nairobi County. We then used traffic probe data to identify areas within a 15-, 30- and 45-min drive from each health facility during peak and off-peak hours and calculated the proportion of the population with access to healthcare in the County. We employed a 2-step floating catchment area model to calculate the ratio of healthcare and healthcare professionals to population during these times. During peak hours, <70% of Nairobi's 4.1 million population was within a 30-min drive from a health facility. This increased to >75% during off-peak hours. In 45 min, the majority of the population had an accessibility index of one health facility accessible to more than 100 people (<0.01) for primary health care facilities, one to 10,000 people for secondary facilities, and two health facilities per 100,000 people for tertiary health facilities. Of people with access to health facilities, a sub-optimal ratio of <4.45 healthcare professionals per 1,000 people was observed in facilities offering primary and secondary healthcare during peak and off-peak hours. Our study shows access to healthcare being negatively impacted by traffic congestion, highlighting the need for multisectoral collaborations between urban planners, health sector and policymakers to optimize health access for the city residents. Additionally, growing availability of traffic probe data in African cities should enable similar analysis and understanding of healthcare access for city residents in other countries on the continent.