How far is the clinic? Urbanicity and sociodemographic variation in the distance to assisted reproductive technology clinics in the USA.

Abstract

Purpose: To quantify the drive time distance to ART clinics overall and by sociodemographic groups and urbanicity for US women ages 15-50.

Methods: Retrospective cross-sectional population-based study. Publicly reported locations of ART clinics (2021) (n = 451), sociodemographic data from the American Community Survey (2020), and geographic boundaries from the US Census (2020) were used to conduct descriptive analyses and urbanicity-stratified multilevel multivariable logistic regression analyses.

Results: In total, 41.9% of women ages 15-50 in the USA were more than 30 min from an ART clinic. Results varied by urbanicity, with 33.9%, 98.7%, and 98.9% of women in metropolitan, micropolitan, and rural tracts more than 30 min from an ART clinic, respectively. Similar variation in the proportion of women in proximity to ART clinics was observed jointly with urbanicity and sociodemographic indicators. Urbanicity-stratified multivariable multilevel models testing the association between tract sociodemographic and population density characteristics and drive time distance to an ART clinic also showed variation across models. For metropolitan areas, positive associations between geographic proximity and a higher proportion of the tract that were Black, Asian, Other race, Hispanic, foreign-born, and with a bachelor's degree or higher were observed. By contrast, few or no significant associations with race, ethnicity, or nativity were observed in micropolitan or rural areas.

Conclusions: Geographic barriers to ART care are widespread but are not fully aligned with observed disparities in treatment utilization, suggesting this barrier may not function as a primary barrier for all underserved groups. Further, urbanicity is an important and understudied component of geographic access to ART.