Jan M. Eberth (
Peiyin Hung, University of South Carolina.
Health Aff (Millwood). 2022 Feb;41(2):237-246. doi: 10.1377/hlthaff.2021.01409.
Examining how spatial access to health care varies across geography is key to documenting structural inequalities in the United States. In this article and the accompanying StoryMap, our team identified ZIP Code Tabulation Areas (ZCTAs) with the largest share of minoritized racial and ethnic populations and measured distances to the nearest hospital offering emergency services, trauma care, obstetrics, outpatient surgery, intensive care, and cardiac care. In rural areas, ZCTAs with high Black or American Indian/Alaska Native representation were significantly farther from services than ZCTAs with high White representation. The opposite was true for urban ZCTAs, with high White ZCTAs being farther from most services. These patterns likely result from a combination of housing policies that restrict housing opportunities and federal health policies that are based on service provision rather than community need. The findings also illustrate the difficulty of using a single metric-distance-to investigate access to care on a national scale.
研究医疗保健的空间可达性如何在地理上存在差异，是记录美国结构性不平等的关键。在本文和相关的 StoryMap 中，我们的团队确定了少数族裔人口比例最大的邮政编码区 (ZCTA)，并测量了到最近提供急诊服务、创伤护理、产科、门诊手术、重症监护和心脏护理的医院的距离。在农村地区，黑人和美国印第安人/阿拉斯加原住民比例较高的 ZCTA 与白人比例较高的 ZCTA 相比，距离服务的距离明显更远。对于城市 ZCTA 而言，情况则相反，白人比例较高的 ZCTA 距离大多数服务更远。这些模式可能是由于住房政策限制住房机会和联邦卫生政策基于服务提供而不是社区需求的综合作用所致。这些发现还说明了使用单一指标——距离——来调查全国范围内的医疗保健可及性的困难。
