Kanegi Skyler L, Rosen Noah L
Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Northwell Health Neuroscience Institute/Zucker School of Medicine, Hofstra University, Great Neck, New York, USA.
Headache. 2022 Nov;62(10):1339-1353. doi: 10.1111/head.14425. Epub 2022 Nov 23.
To characterize the geographic distribution of United States (US) headache subspecialists in 2021 compared to 2012 and analyze trends in distribution of and growth by geography.
Headache disorders are the second-highest cause of disease burden worldwide. Historically, headache disorders have been treated by primary care and emergency physicians, often suboptimally. Our 2012 study identified further disparities in geographic distribution of United Council for Neurologic Subspecialties (UCNS)-certified headache subspecialists.
This correlational population study explores the current geographic distribution of and changes in subspecialists by aggregating data from the UCNS, National Health Interview Survey, US Census, Bureau of Economic Analysis, and American Community Survey.
In 2021, there were 692 UCNS-certified headache subspecialists. There continued to be higher subspecialist density in the Northeast (1:34,678) and Midwest (1:55,005), with the highest density in Vermont (1:12,510) and Connecticut (1:20,419). The highest absolute subspecialist increases were in the South (99), California (35), and Texas (25). The highest relative subspecialist increases were in the West (105%), Vermont (500%), and Mississippi (500%). The univariable regressions showed significant associations between number of subspecialists and adult headache population (R = 0.797, p < 0.001), between subspecialist density and personal income (R = 0.935, p = 0.033), and between growth in subspecialists and poverty rate (R = 0.553, p = 0.022). However, the multivariable regressions showed that only the adult population was significantly associated with number of subspecialists (adjusted R = 0.806, p < 0.001).
Overall, there has been substantial growth in the number of UCNS-certified headache subspecialists in the US, especially relative to growth in adult headache population. Subspecialist density continues to be highest in the Northeast and is associated with higher per capita personal income. However, there has been encouraging growth in geographies that previously had little to no access. These findings represent positive progress, but there is more to be done to both increase access to optimal headache care by subspecialists nationally and decrease geographic disparities in access to care.
描述2021年与2012年相比美国头痛专科医生的地理分布特征，并分析地理分布和增长趋势。
头痛疾病是全球疾病负担的第二大原因。从历史上看，头痛疾病一直由初级保健医生和急诊科医生治疗，效果往往不尽人意。我们2012年的研究发现，美国神经专科联合委员会（UCNS）认证的头痛专科医生在地理分布上存在进一步差异。
这项相关性人群研究通过汇总来自UCNS、国家健康访谈调查、美国人口普查、经济分析局和美国社区调查的数据，探讨了专科医生的当前地理分布和变化情况。
2021年，有692名UCNS认证的头痛专科医生。东北部（1:34,678）和中西部（1:55,005）的专科医生密度仍然较高，佛蒙特州（1:12,510）和康涅狄格州（1:20,419）的密度最高。专科医生绝对增加最多的是南部（99名）、加利福尼亚州（35名）和得克萨斯州（25名）。专科医生相对增加最多的是西部（105%）、佛蒙特州（500%）和密西西比州（500%）。单变量回归显示，专科医生数量与成人头痛患者数量之间存在显著关联（R = 0.797，p < 0.），专科医生密度与个人收入之间存在显著关联（R = 0.935，p = 0.033），专科医生增长与贫困率之间存在显著关联（R = 0.553，p = 0.022）。然而，多变量回归显示，只有成年人口与专科医生数量存在显著关联（调整后R = 0.806，p < 0.001）。
总体而言，美国UCNS认证的头痛专科医生数量有了大幅增长，尤其是相对于成年头痛患者数量的增长。专科医生密度在东北部仍然最高，并且与人均个人收入较高有关。然而，以前几乎没有或根本没有专科医疗服务的地区也出现了令人鼓舞的增长。这些发现代表了积极的进展，但在全国范围内增加专科医生提供最佳头痛护理的可及性以及减少医疗服务可及性的地理差异方面，仍有更多工作要做。
