The proximity of predominantly African American and Hispanic rural communities to physicians and hospital services.
This study assesses how local physician concentrations and distances to hospitals differ for rural communities of varying African American and Hispanic compositions. The authors used data at the town-area level (i.e., towns and their immediately surrounding minor civil divisions and census civil divisions) for 9 Southern and 6 Western states, primarily for 1990. Data were from the US. Census, American Medical Association, and American Hospital Association. Analyses compared nonmetropolitan town-areas with low, medium, and high proportions of African Americans and Hispanics on their local physician-to-population ratios and distances to nearest hospitals offering each of four levels of services. The authors found that Western town-areas having over 50% Hispanic populations had lower physician densities than other Western town-areas that were predominantly non-Hispanic White (24.2 vs. 31.2 physicians per 100,000 population). In Southern town-areas, physician densities did not covary meaningfully with the proportion of African Americans. Distances to the nearest hospitals offering basic, intermediate, and tertiary subspecialty services were generally 25% to 35% farther for Southern town-areas composed of over 60% African Americans and for Western town-areas composed of over 50% Hispanics, compared to communities with more than 80% non-Hispanic White populations within each region. These relationships were not attributable to confounding by extraneous state factors, but in some cases were explained by community sociodemographic differences other than race. Thus, the authors learned that rural communities with populations that are predominantly Hispanic, but not those predominantly African American, face longer travel distances to physicians, and both groups face longer distances to some types of hospital services than rural communities with few minorities.
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 27599, USA. don_pathman@unc.edu
Donald E
DE
Pathman
Thomas R
TR
Konrad
Robert
R
Schwartz
D001741:Black or African American; D002391:Catchment Area, Health; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006780:Hospitals, Rural / Q000600:supply & distribution*; D006801:Humans; D008875:Middle Aged; D010820:Physicians / Q000600:supply & distribution*; D019035:Rural Health Services / Q000600:supply & distribution*; D017062:Small-Area Analysis; D014481:United States