Giovanni Appolon, Shangbin Tang, Nico Gabriel, Jasmine Morales, Lucas A. Berenbrok, Andrea Z. LaCroix, Jingchuan Guo, Walter S. Mathis, Inmaculada Hernandez
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引用次数: 0
Abstract
Background
Pharmacy accessibility is crucial for equity in health care access because community pharmacists may reach individuals who do not have access to other health care providers.
Objective
The objective of this study was to determine whether spatial access to pharmacies differs among racial/ethnic groups across the rural-urban continuum.
Methods
We obtained a 30% random sample of the Research Triangle Institute synthetic population, sampled at the census block level. For each individual, we defined optimal pharmacy access as having a driving distance ≤2 miles to the closest pharmacy in urban counties, ≤5 miles in suburban counties, and ≤10 miles in rural counties. We used a logistic regression model to measure the association between race/ethnicity and pharmacy access, while controlling for racial/ethnic composition of the census tract, area deprivation index, income, age, gender, and U.S. region. The model included an interaction between race/ethnicity and urbanicity to evaluate whether racial/ethnic inequities differed across the rural-urban continuum.
Results
The sample included 90,749,446 individuals of whom 80.6% had optimal pharmacy access. Racial/ethnic inequities in pharmacy access differed across the rural-urban continuum (P value for interaction= <0.0001). In rural areas, Black (OR 0.87; 95% CI 0.86-0.87), Hispanic (OR 0.80; 95% CI 0.79-0.80), and indigenous (OR 0.47; 95% CI 0.47-0.48) individuals had lower odds of optimal pharmacy access, than White individuals. Hispanic (OR 0.96; 95% CI 0.96-0.97) and Indigenous individuals (OR 0.75; 95% CI 0.75-0.76) had lower odds of optimal pharmacy access compared to White individuals in suburban areas. In Western states, Asian had lower odds of optimal pharmacy access in suburban (OR 0.88; 95% CI 0.86-0.90) and rural areas (OR 0.91; 95% CI 0.87-0.95) compared to White individuals.
Conclusions
Racial/ethnic inequities in spatial access to community pharmacies vary between urban and rural communities. Underrepresented racial/ethnic groups have significantly lower pharmacy access in rural and some suburban areas, but not in urban areas.
背景药房的可及性对于医疗保健服务的公平性至关重要,因为社区药剂师可能会接触到那些无法获得其他医疗保健服务提供者服务的人。方法我们从三角研究所合成人口中随机抽取了 30% 的样本,在人口普查区进行抽样。对于每个人,我们将最佳药房访问定义为:在市区县,距离最近药房的车程≤2 英里;在郊区县,距离最近药房的车程≤5 英里;在农村县,距离最近药房的车程≤10 英里。我们使用逻辑回归模型来衡量种族/民族与药房可及性之间的关系,同时控制人口普查区的种族/民族构成、地区贫困指数、收入、年龄、性别和美国地区。该模型包括种族/民族与城市化之间的交互作用,以评估种族/民族不平等现象在城乡之间是否存在差异。不同种族/人种在获得药房服务方面的不平等在城乡之间存在差异(交互作用的 P 值= <0.0001)。在农村地区,黑人(OR 0.87;95% CI 0.86-0.87)、西班牙裔(OR 0.80;95% CI 0.79-0.80)和原住民(OR 0.47;95% CI 0.47-0.48)获得最佳药房服务的几率低于白人。与郊区的白人相比,西班牙裔(OR 0.96;95% CI 0.96-0.97)和原住民(OR 0.75;95% CI 0.75-0.76)获得最佳药房服务的几率较低。在西部各州,与白人相比,亚裔在郊区(OR 0.88;95% CI 0.86-0.90)和农村地区(OR 0.91;95% CI 0.87-0.95)获得最佳药房服务的几率较低。在农村和一些郊区,代表性不足的种族/民族群体获得药房服务的机会明显较少,而在城市地区则不然。
期刊介绍:
The Journal of the American Pharmacists Association is the official peer-reviewed journal of the American Pharmacists Association (APhA), providing information on pharmaceutical care, drug therapy, diseases and other health issues, trends in pharmacy practice and therapeutics, informed opinion, and original research. JAPhA publishes original research, reviews, experiences, and opinion articles that link science to contemporary pharmacy practice to improve patient care.