Geographic Barriers to Subspecialty Care Access for Patients With Primary Immune Disorders in the United States

IF 7.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2026-10-01 Epub Date: 2026-07-24 DOI:10.1016/j.jaip.2026.07.020

Jacob A. Blaukovitch MA, Caitlin P. Blaukovitch DO, Monica G. Lawrence MD, Nicholas L. Rider DO

{"title":"Geographic Barriers to Subspecialty Care Access for Patients With Primary Immune Disorders in the United States","authors":"Jacob A. Blaukovitch MA, Caitlin P. Blaukovitch DO, Monica G. Lawrence MD, Nicholas L. Rider DO","doi":"10.1016/j.jaip.2026.07.020","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Primary immune disorders, also known as inborn errors of immunity, are associated with substantial diagnostic delays and limited access to rural subspecialty and infusion care. This study measures disparities in access to expert clinical immunologists (ECIs) or infusion centers (ICs) relative to primary care resources in the United States.</div></div><div><h3>Objective</h3><div>To evaluate geographic access quantitatively to ECIs, ICs, and federally qualified health centers (FQHCs) across rural and nonrural regions of the United States.</div></div><div><h3>Methods</h3><div>We analyzed publicly available national datasets. Expert clinical immunologists and FQHCs were identified nationally whereas ICs were evaluated in six states and territories. Rurality was characterized using Rural-Urban Commuting Area (RUCA) codes and population density. Chi-square test with <em>post hoc</em> adjusted Pearson residuals (<em>r</em>) assessed associations between facility type and rurality nationally and within the six-state and territory sample. Geographic information system mapping visualized facilities and 2-hour service radii for ECIs.</div></div><div><h3>Results</h3><div>Federally qualified health centers were overrepresented in rural regions, comprising approximately 30% of US FQHCs despite only 20% of the population residing rurally. In contrast, ECIs were underrepresented nationally in rural spaces, and both ECIs and ICs were rurally underrepresented in the six-state and territory sample (ECIs RUCA: <em>r</em> = –2.68; ICs RUCA: <em>r</em> = –2.91). Geographic information system mapping revealed rural ECI coverage in only six states. Findings were consistent across rurality definitions, with RUCA codes demonstrating a balanced characterization of rurality.</div></div><div><h3>Conclusions</h3><div>Rural patients with primary immune disorders, or inborn errors of immunity, face substantial geographic barriers to diagnostic and therapeutic care despite adequate distribution of primary care. Targeted efforts to improve rural subspecialty access are urgently needed.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 10","pages":"Pages 2389-2396"},"PeriodicalIF":7.2000,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Allergy and Clinical Immunology-In Practice","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213219826006021","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/7/24 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ALLERGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Primary immune disorders, also known as inborn errors of immunity, are associated with substantial diagnostic delays and limited access to rural subspecialty and infusion care. This study measures disparities in access to expert clinical immunologists (ECIs) or infusion centers (ICs) relative to primary care resources in the United States.

Objective

To evaluate geographic access quantitatively to ECIs, ICs, and federally qualified health centers (FQHCs) across rural and nonrural regions of the United States.

Methods

We analyzed publicly available national datasets. Expert clinical immunologists and FQHCs were identified nationally whereas ICs were evaluated in six states and territories. Rurality was characterized using Rural-Urban Commuting Area (RUCA) codes and population density. Chi-square test with post hoc adjusted Pearson residuals (r) assessed associations between facility type and rurality nationally and within the six-state and territory sample. Geographic information system mapping visualized facilities and 2-hour service radii for ECIs.

Results

Federally qualified health centers were overrepresented in rural regions, comprising approximately 30% of US FQHCs despite only 20% of the population residing rurally. In contrast, ECIs were underrepresented nationally in rural spaces, and both ECIs and ICs were rurally underrepresented in the six-state and territory sample (ECIs RUCA: r = –2.68; ICs RUCA: r = –2.91). Geographic information system mapping revealed rural ECI coverage in only six states. Findings were consistent across rurality definitions, with RUCA codes demonstrating a balanced characterization of rurality.

Conclusions

Rural patients with primary immune disorders, or inborn errors of immunity, face substantial geographic barriers to diagnostic and therapeutic care despite adequate distribution of primary care. Targeted efforts to improve rural subspecialty access are urgently needed.

查看原文本刊更多论文

美国原发性免疫疾病患者亚专科护理准入的地理障碍

背景：原发性免疫疾病，也被称为先天性免疫错误（PI/IEI），与大量诊断延迟和农村亚专科和输液护理的有限获取有关。本研究测量了在获得专家临床免疫学家（ECIs）或输液中心（ic）相对于初级保健资源在美国的差距。目的：定量评估美国农村和非农村地区ECIs、ic和联邦合格医疗中心（fqhc）的地理可及性。方法：对公开的国家数据集进行分析。eci和fqhc是在全国范围内确定的，而ic在6个州/地区进行了评估。利用城乡通勤区（RUCA）编码和人口密度对乡村性进行表征。采用事后调整Pearson残差(r)的卡方检验评估了全国和6个州/地区样本中设施类型与乡村性之间的关联。地理信息系统（GIS）绘图可视化设施和eci的两小时服务半径。结果：fqhc在农村地区的比例过高，约占美国fqhc的30%，尽管只有20%的人口居住在农村。相比之下，eci在全国农村地区的代表性不足，在6个州/地区的样本中，eci和ic的代表性都不足（eci的RUCA: r = -2.68， ICs的RUCA: r = -2.91）。GIS地图显示农村ECI覆盖范围只有6个州。不同乡村定义的研究结果是一致的，RUCA代码显示了乡村特征的平衡特征。结论：尽管初级保健分布充足，但农村PI/IEI患者在诊断和治疗护理方面面临重大地理障碍。迫切需要有针对性地努力改善农村亚专科的可及性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.