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Pan J, Deng Y, Yang Y, Zhang Y. Location-allocation modelling for rational health planning: Applying a two-step optimization approach to evaluate the spatial accessibility improvement of newly added tertiary hospitals in a metropolitan city of China. Soc Sci Med 2023; 338:116296. [PMID: 37879131 DOI: 10.1016/j.socscimed.2023.116296] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/12/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
The inequity of access to healthcare services is still one of the most long-lasting problems confronted by worldwide countries. Under such context where maldistributed healthcare resources have posed huge challenges in achieving cross-regional efficiency and equity of healthcare services, rational allocation of newly added healthcare resources has become rather critical to policy makers. To address this issue, we applied a two-step optimization approach to investigate the spatial allocation of newly added tertiary general healthcare resources in Chengdu, a metropolitan city of China. The case study of Chengdu was utilized as an example to illustrate the feasibility of such spatial optimization approach in practice in terms of supporting regional health planning related decision-making procedures in China, as well as evaluating the performance of healthcare resource allocation related strategies actually implemented. Using current and historical health planning data, we sought to optimize tertiary general hospitals' locations to maximize population coverage of healthcare services in the first step, and to achieve equitable access to healthcare services among different residential locations via assigning the capacity (beds) to each hospital in the second step. Results suggested that the spatial optimization of newly added healthcare resources would theoretically enhance both efficiency and equity substantially. Specifically, if implemented in practice, such optimized spatial allocation of healthcare resources would theoretically contribute to improved efficiency as reflected by a 5% increase and a 15% increase in population coverage and the weighted median value of spatial accessibility, respectively. In addition, this would contribute to achieve enhanced equity as reflected by a 27% decrease in the weighted standard deviation of spatial access. These findings are anticipated to offer valuable policy implications to inform the spatial allocation decisions of healthcare resources in China as well as other countries confronted with similar challenges, and the two-step optimization approach could be applied to facilitate future rational health plannings.
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Affiliation(s)
- Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; School of Public Administration, Sichuan University, Chengdu, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China.
| | - Yufan Deng
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China.
| | - Yili Yang
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China.
| | - Yumeng Zhang
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China.
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2
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Ohashi K, Osanai T, Bando K, Fujiwara K, Tanikawa T, Tani Y, Takamiya S, Sato H, Morii Y, Ishikawa T, Ogasawara K. Optimal allocation of physicians improves accessibility and workload disparities in stroke care. Int J Equity Health 2023; 22:233. [PMID: 37936211 PMCID: PMC10631210 DOI: 10.1186/s12939-023-02036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Inequalities in access to stroke care and the workload of physicians have been a challenge in recent times. This may be resolved by allocating physicians suitable for the expected demand. Therefore, this study analyzes whether reallocation using an optimization model reduces disparities in spatial access to healthcare and excessive workload. METHODS This study targeted neuroendovascular specialists and primary stroke centers in Japan and employed an optimization model for reallocating neuroendovascular specialists to reduce the disparity in spatial accessibility to stroke treatment and workload for neuroendovascular specialists in Japan. A two-step floating catchment area method and an inverted two-step floating catchment area method were used to estimate the spatial accessibility and workload of neuroendovascular specialists as a potential crowdedness index. Quadratic programming has been proposed for the reallocation of neuroendovascular specialists. RESULTS The reallocation of neuroendovascular specialists reduced the disparity in spatial accessibility and the potential crowdedness index. The standard deviation (SD) of the demand-weighted spatial accessibility index improved from 125.625 to 97.625. Simultaneously, the weighted median spatial accessibility index increased from 2.811 to 3.929. Additionally, the SD of the potential crowdedness index for estimating workload disparity decreased from 10,040.36 to 5934.275 after optimization. The sensitivity analysis also showed a similar trend of reducing disparities. CONCLUSIONS The reallocation of neuroendovascular specialists reduced regional disparities in spatial accessibility to healthcare, potential crowdedness index, and disparities between facilities. Our findings contribute to planning health policies to realize equity throughout the healthcare system.
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Affiliation(s)
- Kazuki Ohashi
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
| | - Toshiya Osanai
- Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N15-W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kyohei Bando
- Graduate School of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
| | - Kensuke Fujiwara
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Graduate School of Commerce, Otaru University of Commerce, 3-5-21, 047-8501, Otaru, Midori, Japan
| | - Takumi Tanikawa
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Faculty of Health Sciences, Hokkaido University of Science, 7-15-4-1, Maeda, Teine-ku, Sapporo, 006- 8585, Japan
| | - Yuji Tani
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Department of Medical Informatics and Hospital Management, Asahikawa Medical University, E2-1-1-1, 078-8510, Asahikawa, Midorigaoka, Japan
| | - Soichiro Takamiya
- Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N15-W7, Kita-ku, Sapporo, 060-8638, Japan
- Department of Neurosurgery, Otaru General Hospital, 1-1-1, Wakamatsu, Otaru, 047-8550, Japan
| | - Hirotaka Sato
- Department of Neurosurgery, Asahikawa Medical University, E2-1-1-1, Midorigaoka, Asahikawa, 078- 8510, Japan
| | - Yasuhiro Morii
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6, Minami, Wako, Japan
| | - Tomoki Ishikawa
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Institute for Health Economics and Policy, 1-21-19, Toranomon, Minato-ku, 105-0001, Japan
| | - Katsuhiko Ogasawara
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan.
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Anguzu R, Walker RJ, Beyer KMM, Zhou Y, Babikako HM, Dickson-Gomez J, Cassidy LD. Spatial accessibility to health facilities among pregnant women with and without exposure to intimate partner violence in Uganda. BMC Pregnancy Childbirth 2023; 23:767. [PMID: 37924014 PMCID: PMC10623746 DOI: 10.1186/s12884-023-06084-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/25/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Poor physical access to health facilities could increase the likelihood of undetected intimate partner violence (IPV) during pregnancy. We aimed to determine sub-regional differences and associations between spatial accessibility to health facilities and IPV among pregnant women in Uganda. METHOD Weighted cross-sectional analyses were conducted using merged 2016 Uganda Demographic and Health Survey and 2014 Uganda Bureau of Statistics health facility datasets. Our study population were 986 women who self-reported being currently pregnant and responded to IPV items. Outcome was spatial accessibility computed as the near point linear distance [< 5 km (optimal) vs. ≥ 5 km (low)] between women's enumeration area and health facility according to government reference cutoffs. Primary independent variable (any IPV) was defined as exposure to at least one of physical, emotional, and sexual IPV forms. Logistic regression models were sequentially adjusted for covariates in blocks based on Andersen's behavioral model of healthcare utilization. Covariates included predisposing (maternal age, parity, residence, partner controlling behavior), enabling (wealth index, occupation, education, economic empowerment, ANC visit frequency), and need (wanted current pregnancy, difficulty getting treatment money, afraid of partner, and accepted partner abuse) factors. RESULTS Respondents' mean age was 26.1 years with ± 9.4 standard deviations (SD), mean number of ANC visits was 3.8 (± 1.5 SD) and 492/986 (49.9%) pregnant women experienced IPV. Median spatial accessibility to the nearest health facility was 4.1 km with interquartile range (IQR) from 0.2 to 329.1 km. Southwestern, and Teso subregions had the highest average percentage of pregnant women experiencing IPV (63.8-66.6%) while Karamoja subregion had the highest median spatial accessibility (7.0 to 9.3 km). In the adjusted analysis, pregnant women exposed to IPV had significantly higher odds of low spatial accessibility to nearest health facilities when compared to pregnant women without IPV exposure after controlling for enabling factors in Model 2 (aOR 1.6; 95%CI 1.2, 2.3) and need factors in Model 3 (aOR 1.5; 95%CI 1.1, 3.8). CONCLUSIONS Spatial accessibility to health facilities were significantly lower among pregnant women with IPV exposure when compared to those no IPV exposure. Improving proximity to the nearest health facilities with ANC presents an opportunity to intervene among pregnant women experiencing IPV. Focused response and prevention interventions for violence against pregnant women should target enabling and need factors.
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Affiliation(s)
- Ronald Anguzu
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Rebekah J Walker
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Kirsten M M Beyer
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Yuhong Zhou
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Harriet M Babikako
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, New Mulago Gate Road, Kampala, Uganda
| | - Julia Dickson-Gomez
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Laura D Cassidy
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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Heikinheimo V, Tiitu M, Viinikka A. Data on different types of green spaces and their accessibility in the seven largest urban regions in Finland. Data Brief 2023; 50:109458. [PMID: 37600595 PMCID: PMC10432942 DOI: 10.1016/j.dib.2023.109458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Access to green spaces in urban regions is vital for the well-being of citizens. In this article, we present data on green space quality and path distances to different types of green spaces. The path distances represent green space accessibility using active travel modes (walking, cycling). The path distances were calculated using the pedestrian street network across the seven largest urban regions in Finland. We derived the green space typology from the Urban Atlas Data that is available across functional urban areas in Europe and enhanced it with national data on water bodies, conservation areas and recreational facilities and routes from Finland. We extracted the walkable street network from OpenStreetMap and calculated shortest paths to different types of green spaces using open-source Python programming tools. Network distances were calculated up to ten kilometers from each green space edge and the distances were aggregated into a 250 m × 250 m statistical grid that is interoperable with various statistical data from Finland. The geospatial data files representing the different types of green spaces, network distances across the seven urban regions, as well as the processing and analysis scripts are shared in an open repository. These data offer actionable information about green space accessibility in Finnish urban regions and support the integration of green space quality and active travel modes into further research and planning activities.
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Affiliation(s)
- Vuokko Heikinheimo
- Finnish Environment Institute Syke, Latokartanonkaari 11, 00790 Helsinki, Finland
| | - Maija Tiitu
- Finnish Environment Institute Syke, Latokartanonkaari 11, 00790 Helsinki, Finland
| | - Arto Viinikka
- Finnish Environment Institute Syke, Latokartanonkaari 11, 00790 Helsinki, Finland
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Luan H, Li G, Duncan DT, Sullivan PS, Ransome Y. Spatial accessibility of pre-exposure prophylaxis (PrEP): different measure choices and the implications for detecting shortage areas and examining its association with social determinants of health. Ann Epidemiol 2023; 86:72-79.e3. [PMID: 37453464 DOI: 10.1016/j.annepidem.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/04/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE We examine how various pre-exposure prophylaxis (PrEP) accessibility measures impact the detection of PrEP shortage areas and the relation of shortage areas to social determinants of health (SDOH). METHODS Using ZIP Code Tabulation Areas (ZCTAs) in New York City as a case study, we compared 25 measures of spatial PrEP accessibility across four categories, including density, proximity, two-step floating catchment area (2SFCA), and Gaussian 2SFCA (G2SFCA). Bayesian spatial regression models were used to examine how PrEP accessibility is associated with SDOH. RESULTS Using density to measure PrEP accessibility for small areas such as ZCTAs poses challenges to statistical modeling because the measured accessibility values are highly skewed with excess zeros, leading to the necessity of using complex models such as the two-part mixture model. When G2SFCA measures are used, which account for distance decay effects and the competition from the PrEP demand side, findings on PrEP shortage area detection and the association between PrEP accessibility and SDOH were more consistent and less sensitive to spatial scales (i.e., varying from 10- to 30-minute driving). CONCLUSIONS This research adds to the nascent research on PrEP accessibility measurement and sheds light on selecting an appropriate measure to assess spatial disparities in PrEP accessibility and its associations with SDOH.
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Affiliation(s)
- Hui Luan
- Department of Geography, University of Oregon, Eugene.
| | - Guangquan Li
- Department of Mathematics, Physics and Electrical Engineering, Northumbria University, Newcastle upon Tyne, UK
| | - Dustin T Duncan
- Mailman School of Public Health, Columbia University, New York, NY
| | | | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT
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6
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Alisan O, Ulak MB, Ozguven EE, Horner MW. Location selection of field hospitals amid COVID-19 considering effectiveness and fairness: A case study of Florida. Int J Disaster Risk Reduct 2023; 93:103794. [PMID: 37309508 PMCID: PMC10251725 DOI: 10.1016/j.ijdrr.2023.103794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/15/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
The world has experienced an unprecedented global health crisis since 2020, the COVID-19 pandemic, which inflicted massive burdens on countries' healthcare systems. During the peaks of the pandemic, the shortages of intensive care unit (ICU) beds illustrated a critical vulnerability in the fight. Many individuals suffering the effects of COVID-19 had difficulty accessing ICU beds due to insufficient capacity. Unfortunately, it has been observed that many hospitals do not have enough ICU beds, and the ones with ICU capacity might not be accessible to all population strata. To remedy this going forward, field hospitals could be established to provide additional capacity in helping emergency health situations such as pandemics; however, location selection is a crucial decision ultimately for this purpose. As such, we consider finding new field hospital locations to serve the demand within certain travel-time thresholds, while accounting for the presence of vulnerable populations. A multi-objective mathematical model is proposed in this paper that maximizes the minimum accessibility and minimizes the travel time by integrating the Enhanced 2-Step Floating Catchment Area (E2SFCA) method and travel-time-constrained capacitated p-median model. This is performed to decide on the locations of field hospitals, while a sensitivity analysis addresses hospital capacity, demand level, and the number of field hospital locations. Four counties in Florida are selected to implement the proposed approach. Findings can be used to identify the ideal location(s) of capacity expansions concerning the fair distribution of field hospitals in terms of accessibility with a specific focus on vulnerable strata of the population.
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Affiliation(s)
- Onur Alisan
- FAMU-FSU College of Engineering, 2525 Pottsdamer Street, Tallahassee, FL, 32310, USA
| | - Mehmet Baran Ulak
- University of Twente, Drienerlolaan 5, 7522, NB, Enschede, the Netherlands
| | - Eren Erman Ozguven
- FAMU-FSU College of Engineering, 2525 Pottsdamer Street, Tallahassee, FL, 32310, USA
| | - Mark W Horner
- Department of Geography, Florida State University, 600 W College Avenue, Tallahassee, FL, 32306, USA
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Pecoraro F, Accordino F, Cecconi F, Paolucci M. Agent Based Modelling for Simulating the Interregional Patient Mobility in Italy. Stud Health Technol Inform 2023; 302:297-301. [PMID: 37203666 DOI: 10.3233/shti230122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Patient mobility is considered one of the main concerns for policy-makers as it impacts financial sustainability of regional health systems due to the high percentage of patients accessing care services in other regions. For a better understanding of this phenomenon, it is necessary to define a behavioral model able to represent the patient-system interaction. In this paper we adopted the Agent-Based Modelling (ABM) approach with the aim of simulating patient flow across regions and determining which are the main factors influencing it. This may provide a new insight for policy makers to capture which are the main factors influencing mobility and actions that may contribute to contain this phenomenon.
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Affiliation(s)
- Fabrizio Pecoraro
- Institute for Research on Population and Social Policies, National Research Council. Rome, Italy
| | - Filippo Accordino
- Institute for Research on Population and Social Policies, National Research Council. Rome, Italy
| | - Federico Cecconi
- Institute of Cognitive Sciences and Technologies, National Research Council. Rome, Italy
| | - Mario Paolucci
- Institute for Research on Population and Social Policies, National Research Council. Rome, Italy
- Institute of Cognitive Sciences and Technologies, National Research Council. Rome, Italy
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Chen H, Cao Y, Feng L, Zhao Q, Torres JRV. Understanding the spatial heterogeneity of COVID-19 vaccination uptake in England. BMC Public Health 2023; 23:895. [PMID: 37189026 DOI: 10.1186/s12889-023-15801-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/02/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Mass vaccination has been a key strategy in effectively containing global COVID-19 pandemic that posed unprecedented social and economic challenges to many countries. However, vaccination rates vary across space and socio-economic factors, and are likely to depend on the accessibility to vaccination services, which is under-researched in literature. This study aims to empirically identify the spatially heterogeneous relationship between COVID-19 vaccination rates and socio-economic factors in England. METHODS We investigated the percentage of over-18 fully vaccinated people at the small-area level across England up to 18 November 2021. We used multiscale geographically weighted regression (MGWR) to model the spatially heterogeneous relationship between vaccination rates and socio-economic determinants, including ethnic, age, economic, and accessibility factors. RESULTS This study indicates that the selected MGWR model can explain 83.2% of the total variance of vaccination rates. The variables exhibiting a positive association with vaccination rates in most areas include proportion of population over 40, car ownership, average household income, and spatial accessibility to vaccination. In contrast, population under 40, less deprived population, and black or mixed ethnicity are negatively associated with the vaccination rates. CONCLUSIONS Our findings indicate the importance of improving the spatial accessibility to vaccinations in developing regions and among specific population groups in order to promote COVID-19 vaccination.
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Affiliation(s)
- Huanfa Chen
- Centre for Advanced Spatial Analysis, University College London, London, UK.
| | - Yanjia Cao
- Department of Geography, The University of Hong Kong, Hong Kong, China
| | - Lingru Feng
- Centre for Advanced Spatial Analysis, University College London, London, UK
- Chongqing Planning and Design Institute, Chongqing, China
- Key Laboratory of Monitoring, Evaluation and Early Warning of Territorial Spatial Planning Implementation, Ministry of Natural Resources, Chongqing, China
| | - Qunshan Zhao
- Urban Big Data Centre, School of Social & Political Sciences, University of Glasgow, Glasgow, UK
- Department of Urban Studies, University of Glasgow, Glasgow, UK
| | - José Rafael Verduzco Torres
- Urban Big Data Centre, School of Social & Political Sciences, University of Glasgow, Glasgow, UK
- Department of Urban Studies, University of Glasgow, Glasgow, UK
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Voicu B, Fărcășanu D, Mustață M, Deliu A, Vișinescu I. Using laws, common sense, and statistical approaches to design indicators for 'medical desertification'. An application on the Romanian case. Soc Sci Med 2023; 327:115944. [PMID: 37150112 DOI: 10.1016/j.socscimed.2023.115944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/30/2023] [Accepted: 04/30/2023] [Indexed: 05/09/2023]
Abstract
The study of spatial accessibility to healthcare services is key to health policy (Pförtner et al., 2019; Vergier et al., 2017). Terms such as 'rurality' or 'medical desertification' were employed to stress the relevance of the topic. Within the existing literature, there is little (if any) concern with the legitimacy of the existing ways to measure inequality. Expert systems were assumed to be in place, and discrepancies or consistency with existing regulations or to views of relevant stakeholders were not considered. This paper discusses spatial accessibility of medical services in three distinct approaches: normative, that is following what national regulations consider as standard; relative, that is what statistical approaches reveal; consensual, which adjusts the indexes based on representations of stakeholders. The three approaches are compared for the case of Romania, an EU country with low population density, ideal to inspect geographical discrepancies. For the relative and the consensual approach, population is adjusted according to different demand expressed by age groups, and also including population and providers from the nearby localities. The normative approach follows official regulations. The refinements in the consensual model are based on survey data from stakeholders and consider distances to neighbouring localities and adjustments according to the age structure of the population in the catchment area. The results reveal high consistency between the consensual and the relative approach. Both are more permissive with respect to detecting medical desertification as compared to the normative approach but prove to be more effective in directing policy when resources are scarce. The normative approach, however, is relevant in depicting the state of the system as contrasted to a desired standard. The relative approach also overlaps with the consensual one. Therefore, to fully characterize spatial accessibility to general practitioners (GPs) and pharmacies, one needs to consider at least the normative and the relative approaches.
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Affiliation(s)
- Bogdan Voicu
- Romanian Academy, Research Institute for Quality of Life, Romania; Lucian Blaga University of Sibiu, Romania; Politehnica University of Bucharest, Romania.
| | | | | | - Alexandra Deliu
- Romanian Academy, Research Institute for Quality of Life, Romania.
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Park J, Michels A, Lyu F, Han SY, Wang S. Daily changes in spatial accessibility to ICU beds and their relationship with the case-fatality ratio of COVID-19 in the state of Texas, USA. Appl Geogr 2023; 154:102929. [PMID: 36960405 PMCID: PMC10011039 DOI: 10.1016/j.apgeog.2023.102929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 06/18/2023]
Abstract
During the COVID-19 pandemic, many patients could not receive timely healthcare services due to limited availability and access to healthcare resources and services. Previous studies found that access to intensive care unit (ICU) beds saves lives, but they overlooked the temporal dynamics in the availability of healthcare resources and COVID-19 cases. To fill this gap, our study investigated daily changes in ICU bed accessibility with an enhanced two-step floating catchment area (E2SFCA) method in the state of Texas. Along with the increased temporal granularity of measurements, we uncovered two phenomena: 1) aggravated spatial inequality of access during the pandemic, and 2) the retrospective relationship between insufficient ICU bed accessibility and the high case-fatality ratio of COVID-19 in rural areas. Our findings suggest that those locations should be supplemented with additional healthcare resources to save lives in future pandemic scenarios.
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Affiliation(s)
- Jinwoo Park
- Department of Geography and Geographic Information Science, University of Illinois Urbana- Champaign, Urbana, IL, USA
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois Urbana- Champaign, Urbana, IL, USA
| | - Alexander Michels
- Department of Geography and Geographic Information Science, University of Illinois Urbana- Champaign, Urbana, IL, USA
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois Urbana- Champaign, Urbana, IL, USA
| | - Fangzheng Lyu
- Department of Geography and Geographic Information Science, University of Illinois Urbana- Champaign, Urbana, IL, USA
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois Urbana- Champaign, Urbana, IL, USA
| | - Su Yeon Han
- Department of Geography and Environmental Studies, Texas State University, San Marcos, TX, USA
| | - Shaowen Wang
- Department of Geography and Geographic Information Science, University of Illinois Urbana- Champaign, Urbana, IL, USA
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois Urbana- Champaign, Urbana, IL, USA
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Zhang T, Qiu Y, Ding R, Yin J, Cao Y, Du Y. Coupling coordination and influencing factors of urban spatial accessibility and economic spatial pattern in the New Western Land-Sea Corridor. Environ Sci Pollut Res Int 2023; 30:54511-54535. [PMID: 36877395 DOI: 10.1007/s11356-023-26121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
The construction of the New Western Land-Sea Corridor is crucial to the economic development of western China and even Southeast Asia. Research analyzes the evolution of urban economic spatial pattern of the New Western Land-Sea Corridor in different years and discusses the coordinated development between economic connection and accessibility and its influencing factors. The research results show that: First, the influence of labor force on the urban centrality of the New Western Land-Sea Corridor is gradually increasing, and the spatial pattern of the urban network has gradually shifted from a unipolar attraction type to a spatial pattern of "one main and multiple subordinates." Second, urban accessibility presents a "core-periphery" spatial pattern, and the coupling coordination degree presents the spatial characteristics of "centro-periphery." The economic correlation strength, spatial accessibility, and the coordinated distribution of the two all have obvious spatial agglomeration characteristics. Third, there are spatial differences in the influencing factors of the coupling coordination degree. Based on this, the research puts forward the development mode of "growth pole," "area," and "axis," attaches importance to the problems of labor force in urban development, and strengthens the level of coupling coordination between regional transportation and economy, to promote the integration of regional transportation, logistics, and economy.
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Affiliation(s)
- Ting Zhang
- College of Big Data Application and Economics (Guiyang College of Big Data Finance), Guizhou University of Finance and Economics, Guiyang, 550025, China
- Pass College of Chongqing Technology and Business University, Chongqing, 401520, China
| | - Yuanhong Qiu
- School of Public Policy and Administration, Chongqing University, Chongqing, 400044, China
| | - Rui Ding
- College of Big Data Application and Economics (Guiyang College of Big Data Finance), Guizhou University of Finance and Economics, Guiyang, 550025, China.
- Guizhou Key Laboratory of Big Data Statistical Analysis, Guizhou University of Finance and Economics, Guiyang, 550025, China.
| | - Jian Yin
- College of Big Data Application and Economics (Guiyang College of Big Data Finance), Guizhou University of Finance and Economics, Guiyang, 550025, China
| | - Yuequn Cao
- School of Public Policy and Administration, Chongqing University, Chongqing, 400044, China
| | - Yiming Du
- College of Big Data Application and Economics (Guiyang College of Big Data Finance), Guizhou University of Finance and Economics, Guiyang, 550025, China
- Guizhou Key Laboratory of Big Data Statistical Analysis, Guizhou University of Finance and Economics, Guiyang, 550025, China
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12
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Jörg R, Haldimann L. MHV3SFCA: A new measure to capture the spatial accessibility of health care systems. Health Place 2023; 79:102974. [PMID: 36708664 DOI: 10.1016/j.healthplace.2023.102974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/27/2023]
Abstract
Good accessibility of health care services is essential to meet the needs of the population and ensure adequate health care coverage. It usually refers to two spatial dimensions: availability (competition between populations for the same medical supply) and reachability (distance between population and medical supply). Traditional indicators of health care accessibility usually fail to consider both of these components simultaneously. Floating-Catchment-Area (FCA) methods were developed to address these shortcomings. This study reviews the existing FCA methods and proposes the Modified Huff-based Variable 3 Steps Floating Catchment Area (MHV3SFCA) method as a new approach. The MHV3SFCA method integrates the strengths of several existing FCA methods into a single method, such as supply competition through the Huff model, and the integration of variable effective catchment sizes. In addition, and as a novelty, the MHV3SFCA relies on the assumption of a constant overall population demand, independent of the distances between population units and supply sites. It also accounts for absolute difference in distances without overestimating distance effects. Based on the results of a simulation study the paper discusses the strengths of the MHV3SFCA method capturing spatial differences in access to health care services.
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Affiliation(s)
- Reto Jörg
- Swiss Health Observatory, Neuchâtel, Switzerland.
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13
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Prajapati N, Soler-Michel P, Vieira VM, Padilla CM. Role of mammography accessibility, deprivation and spatial effect in breast cancer screening participation in France: an observational ecological study. Int J Health Geogr 2022; 21:21. [PMID: 36566241 PMCID: PMC9789573 DOI: 10.1186/s12942-022-00320-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The detection of cancer in its early latent stages can improve patients' chances of recovery and thereby reduce the overall burden of the disease. Our objectives were to investigate factors (geographic accessibility and deprivation level) affecting mammography screening participation variation and to determine how much geographic variation in participation rates can be explained by spillover effects between adjacent areas, while controlling for covariates. METHODS Mammography screening participation rates between 2015 and 2016 were calculated by census blocks (CB), for women aged 50-74 years, residing in Lyon metropolitan area. Global spatial autocorrelation tests were applied to identify the geographic variation of participation. Spatial regression models were used to incorporate spatial structure to estimate associations between mammography participation rate and the combined effect (geographic accessibility and deprivation level) adjusting for modes of travel and social cohesion. RESULTS The mammography participation rate was found to have a statistically significant and positive spatial correlation. The participation rate of one CB was significantly and positively associated with the participation rates of neighbouring CB. The participation was 53.2% in residential and rural areas and 46.6% in urban areas, p < 0.001. Using Spatial Lag models, whereas the population living in most deprived CBs have statistically significantly lower mammography participation rates than lower deprived ones, significant interaction demonstrates that the relation differs according to the degree of urbanization. CONCLUSIONS This study makes an important methodological contribution in measuring geographical access and understanding better the combined effect of deprivation and the degree of urbanization on mammography participation and other contextual factors that affect the decision of using mammography screening services -which is a critical component of healthcare planning and equity.
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Affiliation(s)
- Nirmala Prajapati
- grid.410368.80000 0001 2191 9284Univ Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS-U 1309, 35000 Rennes, France
| | - Patricia Soler-Michel
- Centre Régional de Coordination des Dépistages des Cancers Auvergne Rhône Alpes, Lyon, France
| | - Verónica M. Vieira
- grid.266093.80000 0001 0668 7243Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA USA
| | - Cindy M. Padilla
- grid.410368.80000 0001 2191 9284Univ Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS-U 1309, 35000 Rennes, France
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14
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Zhao Z, Li X, Xu Y, Yang S, Jiang Y, Wang S. Evaluating spatial accessibility of cultural urban land use by using improved 2SFCA method in Xi'an, China. Heliyon 2022; 8:e11993. [PMID: 36506356 PMCID: PMC9732328 DOI: 10.1016/j.heliyon.2022.e11993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/02/2022] [Accepted: 11/23/2022] [Indexed: 12/11/2022] Open
Abstract
With rapid urbanization, contradictions between rapid economic development and a lack of spiritual culture become increasingly complicated. Accessibility is a useful spatial quantitative index to evaluate the spiritual and cultural construction of the city. Amongst various accessibility methods, the two-step floating catchment area (2SFCA) method is suitable for evaluating cultural urban land use (CULU) based on its advantage of flexibility and rationality. This study selects Xi'an as the representative ancient city. Based on comparing accessibility results between different travel modes (walk, bus, subway, and total), and analyzing through statistics, Z-score, and comparison of classification, comparison of a particular area, we obtain the characteristics of CULU accessibility in Xi'an. Firstly, for different travel modes, the distribution of CULU accessibility value in Xi'an is imbalanced, and the accessibility value of bus and subway is closely related to public transport resources. Secondly, CULU in Xi'an has apparent features of being dense in the center, sparse in the suburbs, and lack edge, which correspond to the development of the city. Finally, about 60% accessibility value is contributed by historical CULU, which reflects the typical characteristics of Xi'an as an ancient city with rich historical resources. This study profoundly analyses the attributes of CULU in Xi'an and provides essential data for decision-makers. Furthermore, it gives a significant exploration for building a CULU evaluation system in the future.
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Affiliation(s)
- Ziliang Zhao
- College of Architecture, Xi'an University of Architecture and Technology, Xi'an 710055, China
| | - Xiaolong Li
- College of Architecture, Xi'an University of Architecture and Technology, Xi'an 710055, China,State Key Laboratory of Green Building in Western China, Xi'an University of Architecture and Technology, Xi'an 710055, China
| | - Yuqian Xu
- College of Architecture, Xi'an University of Architecture and Technology, Xi'an 710055, China,State Key Laboratory of Green Building in Western China, Xi'an University of Architecture and Technology, Xi'an 710055, China
| | - Siran Yang
- College of Architecture, Xi'an University of Architecture and Technology, Xi'an 710055, China
| | - Yuan Jiang
- College of Architecture, Xi'an University of Architecture and Technology, Xi'an 710055, China
| | - Shusheng Wang
- College of Architecture, Xi'an University of Architecture and Technology, Xi'an 710055, China,State Key Laboratory of Green Building in Western China, Xi'an University of Architecture and Technology, Xi'an 710055, China,Corresponding author.
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15
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Jia P, Wang Y, Yang M, Wang L, Yang X, Shi X, Yang L, Wen J, Liu Y, Yang M, Xin J, Zhang F, Jiang L, Chi C, Zhang L, Ma X, Ma X, Zhao L, Li W. Inequalities of spatial primary healthcare accessibility in China. Soc Sci Med 2022; 314:115458. [PMID: 36279792 DOI: 10.1016/j.socscimed.2022.115458] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 07/15/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
Abstract
A key step to the establishment of a tiered healthcare system is equitable access to basic primary healthcare services for all. However, no quantitative research on the national status quo of primary healthcare accessibility in China exists. We filled this gap by estimating spatial accessibility to primary healthcare centers (PHCs) and mapping its inequality across the mainland China. Four national datasets during 2015-2018, including administrative boundaries, residential communities, points-of-interest (including PHCs), and road networks, were collected to calculate the distance to the nearest PHC for each community. Five other national datasets including census, elevation, land use, vegetation, and nightlight, were collected to model 100m × 100 m population grids, based on which geographical modeling was used to calculate PHC accessibility of each community. Inequalities in PHC accessibility across China were described with concentration indices. About 44% of communities across China representing approximately 30% of the overall population had no access to PHCs within their 6-km catchment areas; about 78% of communities across China representing approximately 68.4% of the overall population had no access to PHCs within their 1.5-km catchment areas. Some municipalities/provinces like Shanghai, Beijing, Tianjin, Jiangsu, Shandong, and Zhejiang generally had higher proximity to the nearest PHCs, while others like Tibet, Guizhou, and Guangxi had lower proximity to the nearest PHCs. However, assuming similar basic service capacity across all PHCs, Shanghai, Tianjin, and Chongqing showed the lowest PHC accessibility due to high population density. Variations in PHC accessibility existed, with more inequalities observed in the north and northeastern provinces and less inequalities in southwestern and south-central provinces. This study demonstrates primary healthcare accessibility and inequality at province and city levels, and identifies communities with lower proximity and accessibility to PHCs in China. It would serve as a starting point to facilitate precise healthcare planning and preparedness for health emergencies in China.
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Affiliation(s)
- Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, Hubei, China; School of Public Health, Wuhan University, Wuhan, Hubei, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, Hubei, China.
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Min Yang
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Limin Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xuchao Yang
- Ocean College, Zhejiang University, Zhoushan, Zhejiang, China
| | - Xinyu Shi
- University College Twente, University of Twente, Enschede, the Netherlands
| | - Lijian Yang
- Center for Statistical Science, Tsinghua University, Beijing, China
| | - Jin Wen
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Liu
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Maokang Yang
- Division of Rural Health, Sichuan Hospital Association, Chengdu, Sichuan, China
| | - Junguo Xin
- School of Public Health, Chengdu Medical College, Chengdu, Sichuan, China
| | - Fengying Zhang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lihua Jiang
- Department of Health-Related Social and Behavioral Sciences, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunhua Chi
- Department of General Practice, Peking University Health Sciences Center, Beijing, China; Health Management Center, Peking University First Hospital, Beijing, China
| | - Luxia Zhang
- National Institute of Health Data Science, Peking University, Beijing, China; Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Xudong Ma
- Bureau of Medical Administration, National Health Commission of the People's Republic of China, Beijing, China
| | - Xiao Ma
- Department of Health-Related Social and Behavioral Sciences, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Weimin Li
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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16
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Fowler D, Middleton P, Lim S. Extending floating catchment area methods to estimate future hospital bed capacity requirements. Spat Spatiotemporal Epidemiol 2022; 43:100544. [PMID: 36460455 DOI: 10.1016/j.sste.2022.100544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/13/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
A new hospital in north-west Sydney, Australia is to start construction in the year 2023. However, the number of emergency department beds/treatment spaces (EDBs) that it will contain is yet to be determined, as this region is expected to have relatively high population growth from year 2021 to year 2036. In this paper, floating catchment area (FCA) methods were employed to estimate the required number of EDBs for this new hospital. Metrics including spatial accessibility index and spatial equity were calculated based on the predicted populations for 2021 and 2036 using government sourced data. Specifically, potential spatial accessibility and horizontal spatial equity were employed for this paper. Mathematical optimisation was used to determine the most efficient distribution of EDBs throughout different hospitals in this region in 2036. The best allocation of capacity across the study area that simultaneously improved average spatial accessibility and improved spatial equity relative to the metrics of 2021 was found. Traditional methods of healthcare planning seldom consider the spatial location of populations or the travel cost to hospitals. This paper presents a novel method to how capacity of future services are determined due to population growth. These results can be compared to traditional methods to access the validity of the methods outlined in this paper.
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Affiliation(s)
- Daniel Fowler
- School of Civil and Environmental Engineering, Faculty of Engineering, UNSW, Kensington Campus, The University of New South Wales, New South Wales 2052, Australia.
| | - Paul Middleton
- South Western Emergency Research Institute (SWERI), Ingham Institute, 1 Campbell Street, Liverpool, New South Wales 2170, Australia
| | - Samsung Lim
- School of Civil and Environmental Engineering, Faculty of Engineering, UNSW, Kensington Campus, The University of New South Wales, New South Wales 2052, Australia; Biosecurity Program, The Kirby Institute, Faculty of Medicine and Health, The University of New South Wales, New South Wales 2052, Australia
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17
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Cromley G, Lin J. Examining the impact of COVID-19 vaccination rates on differential access to critical care. Appl Geogr 2022; 145:102751. [PMID: 35757493 PMCID: PMC9212364 DOI: 10.1016/j.apgeog.2022.102751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/20/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
The measurement of potential access to health care has focused primarily on what might be called "place-based" access or the differential access among geographic locations rather than between different populations. The vaccination program to inoculate the population against the effects of the COVID-19 virus has created two different at-risk populations. This research examines the impact of COVID-19 vaccination rates on access to critical care for persons fully-vaccinated versus those not fully-vaccinated. In this situation, additional tools are necessary to understand: 1) if there is a significant difference in accessibility between different populations, 2) the magnitude of this difference and how it is distributed across accessibility levels, and 3) how the differences between groups are distributed across the state. A study of access to intensive care unit (ICU) beds by these two populations for the state of Illinois found that although there was a statistically significant difference in access, the magnitude of differences was small. A more important difference was being located in the Chicago Area of the state. The not-fully vaccinated in the Chicago Area had higher than expected spatial access due to the lower need for ICU beds by a higher percentage of fully vaccinated people.
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Affiliation(s)
- Gordon Cromley
- Spatial Literacy Center, Dickinson College, Carlisle, PA, USA
| | - Jie Lin
- School of Earth Sciences, Zhejiang University, Hangzhou, Zhejiang, China
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18
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Mitchell P, Samsel S, Curtin KM, Price A, Turner D, Tramp R, Hudnall M, Parton J, Lewis D. Geographic disparities in access to Medication for Opioid Use Disorder across US census tracts based on treatment utilization behavior. Soc Sci Med 2022; 302:114992. [PMID: 35512612 DOI: 10.1016/j.socscimed.2022.114992] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 03/07/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
Drug overdose is the leading cause of accidental death in the U.S. with deaths from opioid overdose occurring at a higher rate in rural areas. The gaps in the provision of healthcare services have been exacerbated by the opioid crisis leaving vulnerable populations without access to preventative care and education, harm reduction, both chronic and acute treatment of the symptoms of opioid use disorder (OUD), and long-term psychological support for those with OUD and their families. There has been a call in the literature -and a federal mandate-for increased access to opioid treatment facilities, but to date this access has not been operationalized using best practices in geography. Medication for Opioid Use Disorder (MOUD) with FDA-approved methadone or buprenorphine has been shown to increase treatment retention, reduce opioid use and associated health and societal harms, and reduce opioid related overdose, and as such is considered the most effective treatment for OUD. The objective of this study is to examine U.S. adults' spatial access to MOUD - specifically locations of certified Opioid Treatment Programs (OTPs) and DATA-waived Buprenorphine providers. A gravity-based variant of the enhanced two-step floating catchment area model is employed, where friction of distance is based on previously published willingness to travel distances for patients visiting OTPs, to assess how opioid agonist treatment accessibility varies across the nation. Findings suggest that there are extensive 'treatment deserts' where there is little to no physical access to MOUD, especially in rural areas. The significance of this work lies in the incorporation of treatment utilization behavior in the access metric, and the continued confirmation of gaps in access to OUD services despite federal efforts to improve accessibility.
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Affiliation(s)
- Penelope Mitchell
- Department of Geography, Laboratory for Location Science, University of Alabama, Tuscaloosa, AL, USA.
| | - Steven Samsel
- Institute of Data & Analytics, University of Alabama, Tuscaloosa, AL, USA
| | - Kevin M Curtin
- Department of Geography, Laboratory for Location Science, University of Alabama, Tuscaloosa, AL, USA
| | - Ashleigh Price
- Department of Geography, Laboratory for Location Science, University of Alabama, Tuscaloosa, AL, USA
| | - Daniel Turner
- Department of Geography, Laboratory for Location Science, University of Alabama, Tuscaloosa, AL, USA
| | - Ryan Tramp
- Institute of Data & Analytics, University of Alabama, Tuscaloosa, AL, USA
| | - Matthew Hudnall
- Department of Information Systems, Operations Management, and Statistics, University of Alabama, Tuscaloosa, AL, USA
| | - Jason Parton
- Department of Information Systems, Operations Management, and Statistics, University of Alabama, Tuscaloosa, AL, USA
| | - Dwight Lewis
- Department of Management, University of Alabama, Tuscaloosa, AL, USA
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19
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Everhart AR, Ferguson L, Wilson JP. Construction and validation of a spatial database of providers of transgender hormone therapy in the US. Soc Sci Med 2022; 303:115014. [PMID: 35594740 DOI: 10.1016/j.socscimed.2022.115014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/04/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
What little data on transgender healthcare is available often focuses on transgender people's negative experiences in accessing healthcare. However, no research has been conducted that illustrates where gender-affirming hormone therapy, one part of transgender-specific medical care, is available. Without these data, large scale research to discern patterns of availability of and access to gender-affirming medical care is nearly impossible. Community-based organizations, and even trans individuals themselves have constructed repositories and databases of healthcare providers to inform other care seekers where they can access transition-related care providers, but their data are often incomplete, and usually formatted to be user-facing rather than streamlined for research purposes. To fill this gap, this article outlines the methodology for the construction of a spatial database of providers of gender-affirming hormone therapy for transgender people in the US, which is available on GitHub, created from existing community-based resources and the accompanying verification process. The completeness of the database is tested via comparison to data from the US Transgender Survey in which respondents reported travel distance to access transgender-specific care providers. The database accounted for all but 7.5% of respondents who may have accessed unknown facilities based on self-reported travel distance. Results indicate that existing methodologies for database construction regarding healthcare providers are difficult to apply when working with transgender-specific medical care and that tests for replicability and validation often take for granted the wide availability of relevant data and information. While the database unto itself can only demonstrate where care is available, it will enable future research into why these geographic patterns in care availability exist. Finally, the methodology can be replicated to produce databases for other kinds of specialized or politicized medical care such as abortion, gender-affirming surgery, or HIV treatment.
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Affiliation(s)
- Avery R Everhart
- University of Southern California, Dornsife College of Letters, Arts, and Sciences, Spatial Sciences Institute, 3616 Trousdale Parkway, AHF B55, Los Angeles, CA, 90089, USA; Center for Applied Transgender Studies, Chicago, IL, USA.
| | - Laura Ferguson
- University of Southern California, Keck School of Medicine, Institute on Inequalities in Global Health, 2001 N Soto St, Los Angeles, CA, 90032, USA.
| | - John P Wilson
- University of Southern California, Dornsife College of Letters, Arts, and Sciences, Spatial Sciences Institute, 3616 Trousdale Parkway, AHF B55, Los Angeles, CA, 90089, USA.
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20
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Pecoraro F, Luzi D, Clemente F. The Impact of Hospital Accessibility on Interregional Patient Mobility in Italy. Stud Health Technol Inform 2022; 294:684-688. [PMID: 35612176 DOI: 10.3233/shti220556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Patient mobility represents a proxy measure to assess the quality and availability of hospital services, especially in decentralized health systems. Different studies have been focused on the interregional mobility in Italy to capture factors influencing this phenomenon. Among them, hospital capacity is generally captured through the number of beds per population. However, this indicator does not consider the distance to hospitals and the accessibility of extra-regional beds, in particular for patients living at the regional borders. The aim of this paper is to analyse the effect of extra-regional spatial accessibility component on patient mobility among the Italian regions. This can help to capture the level of equity in the provision of services across the country providing a snapshot of the distribution of beds over the territory. Moreover, this study contributes to gain a deeper understanding of the allocation of health resources providing input for policy makers on the basis of the principles of service accessibility.
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Affiliation(s)
- Fabrizio Pecoraro
- Institute for Research on Population and Social Policies, National Research Council. Rome, Italy
| | - Daniela Luzi
- Institute for Research on Population and Social Policies, National Research Council. Rome, Italy
| | - Fabrizio Clemente
- Institute of Crystallography, National Research Council. Monterotondo (Rome), Italy
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21
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Wang J, Li G, Wang J, Nie Q, Yu Y, Xu T. Modeling of emergency support capacity and optimization of delivery service system for urban living materials under uncertain situations: a case study of Xi'an City during COVID-19 epidemic. Comput Urban Sci 2022; 2:47. [PMID: 36589308 PMCID: PMC9789736 DOI: 10.1007/s43762-022-00076-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has brought a heavy burden and severe challenges to the global economy and society, forcing different countries and regions to take various preventive and control measures ranging from normal operations to partial or complete lockdowns. Taking Xi'an city as an example, based on multisource POI data for the government's vegetable storage delivery points, logistics terminal outlets, designated medical institutions, communities, etc., this paper uses the Gaussian two-step floating catchment area method (2SFCA) and other spatial analysis methods to analyze the spatial pattern of emergency support points (ESPs) and express logistics terminals in different situations. It then discusses construction and optimization strategies for urban emergency support and delivery service systems. The conclusions are as follows. (1) The ESPs are supported by large-scale chain supermarkets and fresh supermarkets, which are positively related to the population distribution.The spatial distribution of express logistics terminals is imbalanced, dense in the middle while sparse at the edges. 90% of express terminals are located within a 500 m distance of communities, however, some terminals are shared, which restrict their ability to provide emergency support to surrounding residents. (2) In general, accessibility increases as the number of ESPs increases; under normal traffic, as the distance threshold increases, the available ESPs increase but accessibility slightly decreases; with a traffic lockdown, the travel distance of residents is limited, and as ESPs increase, accessibility and the number of POIs covered significantly increase. (3) The spatial accessibility of the ESPs has a "dumbbell-shaped" distribution, with highest accessibility in the north and south, higher around the second ring road, slightly lower in the center, and lowest near the third ring road at east and west. (4) With the goal of "opening up the logistics artery and unblocking the distribution microcirculation", based on "ESPs + couriers + express logistics terminals + residents", this paper proposes to build and optimize the urban emergency support and delivery service system to improve the comprehensive ability of the city to cope with uncertain risks.
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Affiliation(s)
- Jianpo Wang
- grid.412262.10000 0004 1761 5538College of Urban and Environmental Sciences, Northwest University, 710127 Xi’an, China ,Xi’an Public Security Bureau, 710000 Xi’an, China
| | - Gang Li
- grid.412262.10000 0004 1761 5538College of Urban and Environmental Sciences, Northwest University, 710127 Xi’an, China ,grid.412262.10000 0004 1761 5538Shaanxi Key Laboratory of Earth Surface System and Environmental Carrying Capacity, Northwest University, 710127 Xi’an, China
| | - Jiaobei Wang
- grid.412262.10000 0004 1761 5538College of Urban and Environmental Sciences, Northwest University, 710127 Xi’an, China
| | - Qifan Nie
- grid.411015.00000 0001 0727 7545Department of Civil, Construction and Environmental Engineering, The University of Alabama, 35487 Tuscaloosa, AL USA
| | - Yue Yu
- grid.412262.10000 0004 1761 5538College of Urban and Environmental Sciences, Northwest University, 710127 Xi’an, China
| | - Tingting Xu
- grid.412262.10000 0004 1761 5538College of Urban and Environmental Sciences, Northwest University, 710127 Xi’an, China
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Cao C, Li Y, Fu S, Zhang Y, Li N, Hou S, Fan H. Patient delay in a coronavirus disease 2019 (COVID-19) outbreak in Tianjin, China from January to February 2020. J Formos Med Assoc 2021; 121:1248-1256. [PMID: 34802833 PMCID: PMC8580809 DOI: 10.1016/j.jfma.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/10/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022] Open
Abstract
Background Patient delay of COVID-19 patients occurs frequently, which poses a challenge to the overall epidemic situation. In this study, we aimed to evaluate the extent of patient delay, explore its factors, and investigate the effects of patient interval on epidemic situation. Methods A retrospective cohort study was conducted with 136 COVID-19 patients in Tianjin, China. Factors associated with patient delay were explored using logistic regression models. The relationship was investigated by spearman correlation analysis and mean absolute error between patient interval of lagging days and epidemic situation. Results The factors associated with patient delay of COVID-19 patients were mainly the imported cases, the first presentation to a tertiary hospital, close contacts and spatial accessibility to fever clinic. The longer the patient intervals of lagging days, the greater the number of new-onset and confirmed cases in 3–4 and 5–7 days after the first day symptoms, respectively. Conclusion Identification and quarantine of close contacts, promoting the spatial accessibility to fever clinics and creating public awareness are crucial to shortening patient delays to flat the curve for COVID-19.
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Affiliation(s)
- Chunxia Cao
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, PR China
| | - Yue Li
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, PR China
| | - Shaobo Fu
- General Courses Department, Army Military Transportation University of PLA, Tianjin 300161, PR China
| | - Yongzhong Zhang
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, PR China
| | - Ning Li
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, PR China
| | - Shike Hou
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, PR China.
| | - Haojun Fan
- Institute of Disaster Medicine, Tianjin University, Tianjin, 300072, PR China.
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Sharpe JD, Guest JL, Siegler AJ, Sanchez TH, Sullivan PS. The spatiotemporal distribution of pre-exposure prophylaxis accessibility in the United States, 2016-2020. Ann Epidemiol 2021; 64:102-110. [PMID: 34563567 DOI: 10.1016/j.annepidem.2021.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/21/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Residing in areas with little spatial accessibility to HIV pre-exposure prophylaxis (PrEP) providers, or PrEP deserts, contributes to low PrEP uptake. This study examines and characterizes the spatial distribution of PrEP accessibility in the United States over time. METHODS We conducted spatial network analyses and geographic mapping to explore the spatiotemporal distribution of persistent PrEP deserts (census tracts with suboptimal accessibility in 2016 and 2020), new PrEP deserts (tracts with suboptimal accessibility in 2020 but not 2016), new PrEP oases (tracts with suboptimal accessibility in 2016 but not 2020), and persistent PrEP oases (tracts with optimal accessibility in 2016 and 2020). We used polytomous logistic regression to determine area-level factors associated with these four spatiotemporal PrEP accessibility types. RESULTS There was a reduction of 52.8% in the prevalence of 30-minute PrEP deserts from 2016 (28,055 tracts) to 2020 (13,240 tracts) and an increase of 33.5% in 30-minute PrEP oases from 2016 (44,259 tracts) to 2020 (59,074 tracts). Of all tracts, 12,487 (17.3%) were persistent PrEP deserts, 753 (1.0%) were new PrEP deserts, 15,568 (21.5%) were new PrEP oases, and 43,506 (60.1%) were persistent PrEP oases. Overall, persistent PrEP oases were more likely to be of higher socioeconomic status, racially/ethnically diverse, located in urban areas, and located in the Northeast compared with other spatiotemporal PrEP accessibility types, with variation by urbanicity and U.S. Census region. CONCLUSIONS Efforts to improve PrEP accessibility should be especially focused in disadvantaged communities in nonurban areas and the South, Midwest, and West. Monitoring changes in the spatial accessibility of PrEP over time and determining the factors associated with such changes can help to evaluate progress made towards improving PrEP accessibility.
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Affiliation(s)
- J Danielle Sharpe
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Jodie L Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Mohammadi A, Mollalo A, Bergquist R, Kiani B. Measuring COVID-19 vaccination coverage: an enhanced age-adjusted two-step floating catchment area model. Infect Dis Poverty 2021; 10:118. [PMID: 34530923 PMCID: PMC8443959 DOI: 10.1186/s40249-021-00904-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There are only limited studies on access to COVID-19 vaccines and identifying the most appropriate health centres for performing vaccination in metropolitan areas. This study aimed to measure potential spatial access to COVID-19 vaccination centres in Mashhad, the second-most populous city in Iran. METHODS The 2021 age structure of the urban census tracts was integrated into the enhanced two-step floating catchment area model to improve accuracy. The model was developed based on three different access scenarios: only public hospitals, only public healthcare centres and both (either hospitals or healthcare centres) as potential vaccination facilities. The weighted decision-matrix and analytic hierarchy process, based on four criteria (i.e. service area, accessibility index, capacity of vaccination centres and distance to main roads), were used to choose potential vaccination centres looking for the highest suitability for residents. Global Moran's index (GMI) was used to measure the spatial autocorrelation of the accessibility index in different scenarios and the proposed model. RESULTS There were 26 public hospitals and 271 public healthcare centres in the study area. Although the exclusive use of public healthcare centres for vaccination can provide the highest accessibility in the eastern and north-eastern parts of the study area, our findings indicate that including both public hospitals and public healthcare centres provide high accessibility to vaccination in central urban part. Therefore, a combination of public hospitals and public healthcare centres is recommended for efficient vaccination coverage. The value of GMI for the proposed model (accessibility to selected vaccination centres) was calculated as 0.53 (Z = 162.42, P < 0.01). Both GMI and Z-score values decreased in the proposed model, suggesting an enhancement in accessibility to COVID-19 vaccination services. CONCLUSIONS The periphery and poor areas of the city had the least access to COVID-19 vaccination centres. Measuring spatial access to COVID-19 vaccination centres can provide valuable insights for urban public health decision-makers. Our model, coupled with geographical information systems, provides more efficient vaccination coverage by identifying the most suitable healthcare centres, which is of special importance when only few centres are available.
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Affiliation(s)
- Alireza Mohammadi
- Department of Geography and Urban Planning, Faculty of Social Sciences, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Abolfazl Mollalo
- Department of Public Health and Prevention Science, School of Health Sciences, Baldwin Wallace University, Berea, OH, USA
| | - Robert Bergquist
- Ingerod, Brastad, Sweden (formerly with the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization), Geneva, Switzerland
| | - Behzad Kiani
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Kim K, Ghorbanzadeh M, Horner MW, Ozguven EE. Identifying areas of potential critical healthcare shortages: A case study of spatial accessibility to ICU beds during the COVID-19 pandemic in Florida. Transp Policy (Oxf) 2021; 110:478-486. [PMID: 34257481 PMCID: PMC8263167 DOI: 10.1016/j.tranpol.2021.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/05/2021] [Indexed: 05/24/2023]
Abstract
Healthcare resource availability is potentially associated with COVID-19 mortality, and the potentially uneven geographical distribution of resources is a looming concern in the global pandemic. Given that access to healthcare resources is important to overall population health, assessing COVID-19 patients' access to healthcare resources is needed. This paper aims to examine the temporal variations in the spatial accessibility of the U.S. COVID-19 patients to medical facilities, identify areas that are likely to be overwhelmed by the COVID-19 pandemic, and explore associations of low access areas with their socioeconomic and demographic characteristics. We use a three-step floating catchment area method, spatial statistics, and logistic regression to achieve the goals. Findings of this research in the State of Florida revealed that North Florida, rural areas, and zip codes with more Latino or Hispanic populations are more likely to have lower access than other regions during the COVID-19 pandemic. Our approach can help policymakers identify potentially possible low access areas and establish appropriate policy intervention paying attention to those areas during a pandemic.
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Affiliation(s)
- Kyusik Kim
- Department of Geography, Florida State University, 600 W College Avenue, Tallahassee, FL, 32306, USA
| | - Mahyar Ghorbanzadeh
- Department of Civil and Environmental Engineering, Florida A&M University-Florida State University College of Engineering, Florida State University, 2525 Pottsdamer Street, Tallahassee, FL, 32310, USA
| | - Mark W Horner
- Department of Geography, Florida State University, 600 W College Avenue, Tallahassee, FL, 32306, USA
| | - Eren Erman Ozguven
- Department of Civil and Environmental Engineering, Florida A&M University-Florida State University College of Engineering, Florida State University, 2525 Pottsdamer Street, Tallahassee, FL, 32310, USA
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Ghorbanzadeh M, Kim K, Erman Ozguven E, Horner MW. Spatial accessibility assessment of COVID-19 patients to healthcare facilities: A case study of Florida. Travel Behav Soc 2021; 24:95-101. [PMID: 33777697 PMCID: PMC7980178 DOI: 10.1016/j.tbs.2021.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/26/2021] [Accepted: 03/12/2021] [Indexed: 05/05/2023]
Abstract
During the COVID-19 pandemic, healthcare facilities worldwide have been overwhelmed by the amount of coronavirus patients needed to be served. Similarly, the U.S. also experienced a shortage of healthcare resources, which led to a reduction in the efficiency of the whole healthcare system. In order to evaluate this from a transportation perspective, it is critical to understand the extent to which healthcare facilities with intensive care unit (ICU) beds are available in both urban and rural areas. As such, this study aims to assess the spatial accessibility of COVID-19 patients to healthcare facilities in the State of Florida. For this purpose, two methods were used: the two-step floating catchment area (2SFCA) and the enhanced two-step floating catchment area (E2SFCA). These methods were applied to identify the high and low access areas in the entire state. Furthermore, a metric, namely the Accessibility Ratio Difference (ARD), was developed to evaluate the spatial access difference between the models. Results revealed that many areas in the northwest and southern Florida have lower access compared to other locations. The residents in central Florida (e.g., Tampa and Orlando cities) had the highest level of accessibility given their higher access ratios. We also observed that the 2SFCA method overestimates the accessibility in the areas with a lower number of ICU beds due to the "equal access" assumption of the population within the catchment area. The findings of this study can provide valuable insights and information for state officials and decision makers in the field of public health.
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Affiliation(s)
- Mahyar Ghorbanzadeh
- Department of Civil and Environmental Engineering, FAMU-FSU College of Engineering, Florida State University, 2525 Pottsdamer Street, Tallahassee, FL 32310, United Sates
| | - Kyusik Kim
- Department of Geography, Florida State University, 600 W College Avenue, Tallahassee, FL 32306, United Sates
| | - Eren Erman Ozguven
- Department of Civil and Environmental Engineering, FAMU-FSU College of Engineering, Florida State University, 2525 Pottsdamer Street, Tallahassee, FL 32310, United Sates
| | - Mark W Horner
- Department of Geography, Florida State University, 600 W College Avenue, Tallahassee, FL 32306, United Sates
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张 佳, 韩 沛, 杨 莉. [ Spatial accessibility of fever clinics for multi-tiered prevention and control on COVID-19 in Beijing]. Beijing Da Xue Xue Bao Yi Xue Ban 2021; 53:543-548. [PMID: 34145858 PMCID: PMC8220033 DOI: 10.19723/j.issn.1671-167x.2021.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To simulate the different prevalence of corona virus disease 2019 (COVID-19) in Beijing as the spreading and the outbreak city and analyze the response capacity of its medical resources of fever clinics, and to provide a scientific basis for optimizing the spatial layout in Beijing under severe epidemics. METHODS The study obtained epidemiological indicators for COVID-19, factors about medical resources and population movement as parameters for the SEIR model and utilized the model to predict the maximum number of infections on a single day at different control levels in Beijing, simulated as an epidemic spreading city and an epidemic outbreak city respectively. The modified two-step floating catchment area method under ArcGIS 10.6 environment was used to analyze spatial accessibility to fever clinics services for the patients in Beijing. RESULTS According to the results of the SEIR model, the highest number of infections in a single day in Beijing simulated as an epidemic spreading city at low, medium and high levels of prevention and control were 8 514, 183, and 68 cases, the highest number of infections in a single day in Beijing simulated as an outbreak city was 22 803, 10 868 and 3 725 cases, respectively. The following result showed that Beijing was simulated as an epidemic spreading city: among the 585 communities in Beijing, under the low level of prevention and control, there were 17 communities (2.91%) with excellent accessibility to fever clinics, and that of 41 communities (7.01%) with fever clinics was good. Spatial accessibility of fever clinics in 56 communities (9.57%) was ranked average, and 62 communities' (10.60%) accessibility was fair and 409 communities (69.91%) had poor accessibility; at the medium level of prevention and control, only the west region of Fangshan District and Mentougou District, the north region of Yanqing District, Huairou District and Miyun District had poor accessibility; under the high level of prevention and control, 559 communities' (95.56%) had excellent accessibility. The accessibility in 24 communities (4.10%) was good and in 2 communities (0.34%) was average. In brief, the existing fever clinics could meet the common demand. Beijing was simulated as an outbreak city: under the low level of prevention and control, only 1 community (0.17%) had excellent accessibility to fever clinics, and 5 communities (0.86%) had good accessibility. The accessibility of fever clinics in 10 communities (1.71%) was average and in 12 communities (2.05%) was fair. The accessibility of fever clinics in 557 communities (95.21%), nearly all areas of Beijing, was poor; under the middle and high level of prevention and control, the accessibility of ecological conservation areas was also relatively poor. CONCLUSION The distribution of fever clinic resources in Beijing is uneven. When Beijing is simulated as an epidemic spreading city: under the high level of prevention and control, the number of fever clinics can be appropriately reduced to avoid cross-infection; at the medium level of prevention and control, the fever clinics can basically meet the needs of patients with fever in Beijing, but the accessibility of fever clinics in ecological conservation areas is insufficient, and priority should be given to the construction of fever clinics in public hospitals above the second level in the ecological conservation areas. When the level of prevention and control is low, the accessibility of fever clinics in ecological conservation areas is poor. Priority should be given to the construction of fever clinics in ecological conservation areas, and temporary fever sentinels can be established to relieve the pressure of fever clinics. When Beijing is simulated as an outbreak city and has low prevention and control, due to a large number of infections, it is necessary to upgrade the prevention and control level to reduce the flow of people to curb the development of the epidemic.
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Affiliation(s)
- 佳伟 张
- />北京大学公共卫生学院卫生政策与管理系,北京 100191Department of Health Policy and Management, Peking University School of Public Health, Beijing 100191, China
| | - 沛恩 韩
- />北京大学公共卫生学院卫生政策与管理系,北京 100191Department of Health Policy and Management, Peking University School of Public Health, Beijing 100191, China
| | - 莉 杨
- />北京大学公共卫生学院卫生政策与管理系,北京 100191Department of Health Policy and Management, Peking University School of Public Health, Beijing 100191, China
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Pecoraro F, Luzi D, Clemente F. Spatial Inequity in Access to Intensive Care Unit Beds at Regional Level in Italy. Stud Health Technol Inform 2021; 281:809-813. [PMID: 34042690 DOI: 10.3233/shti210287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The high demand of hospitalization in the intensive care units (ICUs) during the first wave of the COVID-19 outbreak brought out the critical issues of the limited capacity of the regional systems to deal with high patient inflows in a short period of time. In this view, a rapid and efficient reallocation of resources is one of the main challenges to be addressed by regional systems to prevent overload and saturation. Aim of this study is to assess the spatial accessibility of ICU beds in the 20 Italian regions to capture the equity distribution of critical care services across the country. This analysis may contribute to gain a deeper understanding of the allocation of health resources. It can provide input for policy makers in view of a possible reorganization of the national system in terms of both its preparedness for emergency period and routine capability.
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Affiliation(s)
- Fabrizio Pecoraro
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Daniela Luzi
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | - Fabrizio Clemente
- Institute of Crystallography, National Research Council, Monterotondo (Rome), Italy
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Tsai CH, Ren P, Elyasi F, Manduchi R. Finding Your Way Back: Comparing Path Odometry Algorithms for Assisted Return. Proc IEEE Int Conf Pervasive Comput Commun 2021; 2021:117-122. [PMID: 34308095 DOI: 10.1109/percomworkshops51409.2021.9431082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We present a comparative analysis of inertial-based odometry algorithms for the purpose of assisted return. An assisted return system facilitates backtracking of a path previously taken, and can be particularly useful for blind pedestrians. We present a new algorithm for path matching, and test it in simulated assisted return tasks with data from WeAllWalk, the only existing data set with inertial data recorded from blind walkers. We consider two odometry systems, one based on deep learning (RoNIN), and the second based on robust turn detection and step counting. Our results show that the best path matching results are obtained using the turns/steps odometry system.
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Affiliation(s)
- Chia Hsuan Tsai
- Dept. of Computer Science & Engineering, University of California, Santa Cruz
| | - Peng Ren
- Dept. of Computer Science & Engineering, University of California, Santa Cruz
| | - Fatemeh Elyasi
- Dept. of Computer Science & Engineering, University of California, Santa Cruz
| | - Roberto Manduchi
- Dept. of Computer Science & Engineering, University of California, Santa Cruz
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Kiani B, Mohammadi A, Bergquist R, Bagheri N. Different configurations of the two-step floating catchment area method for measuring the spatial accessibility to hospitals for people living with disability: a cross-sectional study. Arch Public Health 2021; 79:85. [PMID: 34022968 PMCID: PMC8141247 DOI: 10.1186/s13690-021-00601-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 05/04/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Poor spatial accessibility to hospital services is associated with higher morbidity and mortality rates among people living with disability. Improved methods to evaluate spatial accessibility are needed. This study measured the potential spatial accessibility of people living with disability by applying four configurations of the two-step floating catchment area (2SFCA) method to recommend the best model for use in health services research. METHODS 2SFCA and an enhanced version (E2SFCA) were used to measure hospital accessibility for people living with disability. We also developed and embedded a non-spatial severity index into the two 2SFCA models. We used 16,186 records of people living with disability experience to evaluate the methodological performance across 68 neighbourhoods of the city of Ahvaz, located in south-western Iran. The models' performance were measured through correlation of the four accessibility scores with the distance to closest hospital for each neighbourhood centroid. RESULTS Among the four models used to measure spatial accessibility, the E2SFCA integrated with the severity index displayed the best performance. Most people with disabilities lived in neighbourhoods located in the South-western and central areas of the city. Interestingly, south-western neighbourhoods had poor hospital accessibility score and were identified as unmet need areas for access to health services. CONCLUSIONS Inclusion of the severity factor in the E2SFCA improved access measurements. Identifying areas with poor levels of hospital accessibility can help policymakers design tailored interventions and improve accessibility to hospital-based care in urban settings for people living with disability.
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Affiliation(s)
- Behzad Kiani
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Mohammadi
- Department of Geography and Urban Planning, Faculty of Social Sciences, University of Mohaghegh Ardabili, Ardabil, Iran.
| | - Robert Bergquist
- Ingerod, Brastad, Sweden (formerly with the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization), Geneva, Switzerland
| | - Nasser Bagheri
- Visualization and Decision Analytics (VIDEA) lab, Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
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Gao F, languille C, karzazi K, Guhl M, Boukebous B, Deguen S. Efficiency of fine scale and spatial regression in modelling associations between healthcare service spatial accessibility and their utilization. Int J Health Geogr 2021; 20:22. [PMID: 34011390 PMCID: PMC8136234 DOI: 10.1186/s12942-021-00276-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/08/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Healthcare accessibility, a key public health issue, includes potential (spatial accessibility) and realized access (healthcare utilization) dimensions. Moreover, the assessment of healthcare service potential access and utilization should take into account the care provided by primary and secondary services. Previous studies on the relationship between healthcare spatial accessibility and utilization often used conventional statistical methods without addressing the scale effect and spatial processes. This study investigated the impact of spatial accessibility to primary and secondary healthcare services on length of hospital stay (LOS), and the efficiency of using a geospatial approach to model this relationship. METHODS This study focused on the ≥ 75-year-old population of the Nord administrative region of France. Inpatient hospital spatial accessibility was computed with the E2SFCA method, and then the LOS was calculated from the French national hospital activity and patient discharge database. Ordinary least squares (OLS), spatial autoregressive (SAR), and geographically weighted regression (GWR) were used to analyse the relationship between LOS and spatial accessibility to inpatient hospital care and to three primary care service types (general practitioners, physiotherapists, and home-visiting nurses). Each model performance was assessed with measures of goodness of fit. Spatial statistical methods to reduce or eliminate spatial autocorrelation in the residuals were also explored. RESULTS GWR performed best (highest R2 and lowest Akaike information criterion). Depending on global model (OLS and SAR), LOS was negatively associated with spatial accessibility to general practitioners and physiotherapists. GWR highlighted local patterns of spatial variation in LOS estimates. The distribution of areas in which LOS was positively or negatively associated with spatial accessibility varied when considering accessibility to general practitioners and physiotherapists. CONCLUSIONS Our findings suggest that spatial regressions could be useful for analysing the relationship between healthcare spatial accessibility and utilization. In our case study, hospitalization of elderly people was shorter in areas with better accessibility to general practitioners and physiotherapists. This may be related to the presence of effective community healthcare services. GWR performed better than LOS and SAR. The identification by GWR of how these relationships vary spatially could bring important information for public healthcare policies, hospital decision-making, and healthcare resource allocation.
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Affiliation(s)
- Fei Gao
- HESP, 35000 Rennes, France
- Recherche en Pharmaco-Épidémiologie Et Recours Aux Soins, L’équipe REPERES, UPRES EA-7449, Rennes, France
- Department of Quantitative Methods for Public Health, EHESP School of Public Health, Avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Clara languille
- HESP, 35000 Rennes, France
- Univ Rennes, Ensai, 35000 Rennes, France
| | - Khalil karzazi
- HESP, 35000 Rennes, France
- Univ Rennes, Ensai, 35000 Rennes, France
| | - Mélanie Guhl
- HESP, 35000 Rennes, France
- Univ Rennes, Ensai, 35000 Rennes, France
| | - Baptiste Boukebous
- ECAMO, UMR1153, CRESS, INSERM, Paris, France
- Hoptial Bichât /Beaujon, APHP, Paris, France
| | - Séverine Deguen
- HESP, 35000 Rennes, France
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis D’Épidémiologie Et de Santé Publique, IPLESP, 75012 Paris, France
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Efriandi T. Spatial access to health care: a case study on community health centers in Asmat District, Papua, Indonesia. J Public Health Policy 2021; 42:113-126. [PMID: 33436967 DOI: 10.1057/s41271-020-00267-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2020] [Indexed: 11/21/2022]
Abstract
In recent decades, access to primary health care has become a crucial issue for health policy planners and researchers. One of the fundamental problems is inequitable access to health care due to imbalanced resource distributions between health care providers and population location. Accordingly, this study aims to examine the spatial access to Community Health Centers (CHC) in the Asmat district, one of the most isolated regions in Papua, Indonesia. We conducted the study using a two-step floating catchment area (2SFCA) method to quantify accessibility value to primary health care of each village in the district of Asmat. By taking five distance thresholds ranging from 5 to 25 km with an increment of 5 km, the results indicate that distance has a varying impact on each village. For example, within a 5-km distance threshold, 74% of villages have a zero score or have no access to CHCs, 22% have a score < 100, while only 4% of villages have a score > 100 or meet the minimum score recommended by World Health Organization (WHO). Two major related factors of these geographic disparities are the unequal distribution of CHCs and the high population dispersion. As an attempt to provide equal access to health care services, these results suggest that spatial access should be conscientiously considered by health planners and policy makers.
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Affiliation(s)
- Tri Efriandi
- Department of Spatial Planning and Environment, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9747 AD, Groningen, The Netherlands.
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Subal J, Paal P, Krisp JM. Quantifying spatial accessibility of general practitioners by applying a modified huff three-step floating catchment area (MH3SFCA) method. Int J Health Geogr 2021; 20:9. [PMID: 33596931 PMCID: PMC7888693 DOI: 10.1186/s12942-021-00263-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND It is necessary to ensure sufficient healthcare. The use of current, precise and realistic methods to model spatial accessibility to healthcare and thus improved decision-making is helping this process. Generally, these methods-which include the family of floating catchment area (FCA) methods-incorporate a number of criteria that address topics like access, efficiency, budget, equity and the overall system utilization. How can we measure spatial accessibility? This paper investigates a sophisticated approach for quantifying the spatial accessibility of general practitioners. (GPs). Our objective is the investigation and application of a spatial accessibility index by an improved Huff three-step floating catchment area (MH3SFCA) method. METHODS We modify and implement the huff model three-step floating catchment area (MH3SFCA) method and exemplary calculation of the spatial accessibility indices for the test study area. The method is extended to incorporate a more realistic way to model the distance decay effect. To that end, instead of a binary approach, a continuous approach is employed. Therefore, each distance between a healthcare site and the population is incorporated individually. The study area includes Swabia and the city of Augsburg, Germany. The data for analysis is obtained from following data sources: (1) Acxiom Deutschland GmbH (2020) provided a test dataset for the locations of general practitioners (GPs); (2) OpenStreetMap (OSM) data is utilized for road networks; and (3) the Statistische Ämter des Bundes und der Länder (German official census 2011) provided a population distribution dataset stemming from the 2011 Census. RESULTS The spatial accessibility indices are distributed in an inhomogeneous as well as polycentric pattern for the general practitioners (GPs). Differences in spatial accessibility are found mainly between urban and rural areas. The transitions from lower to higher values of accessibility or vice versa in general are smooth rather than abrupt. The results indicate that the MH3SFCA method is suited for comparing the spatial accessibility of GPs in different regions. The results of the MH3SFCA method can be used to indicate over- and undersupplied areas. However, the absolute values of the indices do not inherently define accessibility to be too low or too high. Instead, the indices compare the spatial relationships between each supply and demand location. As a result, the higher the value of the accessibility indices, the higher the opportunities for the respective population locations. The result for the study area are exemplary as the test input data has a high uncertainty. Depending on the objective, it might be necessary to further analyze the results of the method. CONCLUSIONS The application of the MH3SFCA method on small-scale data can provide an overview of accessibility for the whole study area. As many factors have to be taken into account, the outcomes are too complex for a direct and clear interpretation of why indices are low or high. The MH3SFCA method can be used to detect differences in accessibility on a small scale. In order to effectively detect over- or undersupply, further analysis must be conducted and/or different (legal) constraints must be applied. The methodology requires input data of high quality.
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Affiliation(s)
- Julia Subal
- Applied Geoinformatics, University of Augsburg, Institute of Geography, Alter Postweg 118, 86159, Augsburg, Germany
| | - Piret Paal
- WHO Collaborating Centre, Institute for Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Jukka M Krisp
- Applied Geoinformatics, University of Augsburg, Institute of Geography, Alter Postweg 118, 86159, Augsburg, Germany.
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Bensley KMK, Karriker-Jaffe KJ, Cherpitel C, Li L, Wallisch LS, Zemore SE. Limited treatment accessibility: Implications for alcohol treatment disparities among Mexican Americans living in the U.S.-Mexico border region. J Subst Abuse Treat 2020; 121:108162. [PMID: 33172725 DOI: 10.1016/j.jsat.2020.108162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 09/12/2020] [Accepted: 10/05/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Receipt of alcohol-related care for alcohol use is particularly low among those residing in the U.S.-Mexico border region. One reason for this disparity may be limited treatment accessibility, making it difficult for those who need it to access needed treatment. The current study assesses whether differences in treatment utilization are mediated by differences in treatment accessibility in cities within and outside of the border region. METHODS We used data from the U.S.-Mexico Study of Alcohol and Related Conditions involving a probability sample of Mexican-origin adults surveyed in three cities in Texas (2011-2013). We included only participants with a lifetime history of alcohol use disorder (AUD) (n = 792). We examined two lifetime measures of self-reported alcohol treatment utilization: considering getting help for an alcohol problem and receipt of treatment. We geocoded locations of facilities listed in the SAMHSA National Directory of Drug and Alcohol Abuse Treatment Facilities. We considered three types of facilities: any outpatient treatment, programs offering fee assistance, and programs offering Spanish-language services. We measured treatment accessibility by density of treatment (i.e., number of facilities within a 20-mile radius of participant's residence) and proximity to treatment (i.e., travel time to nearest facility). We assessed direct and indirect effects of two cities in the border region (versus one nonborder city) on the outcomes through treatment accessibility using generalized structural equation models that accounted for clustering of respondents in cities and in neighborhoods, weighted for sampling and nonresponse and adjusted for covariates. RESULTS Of 792 respondents with lifetime AUD, 22% had considered getting help and 11% had received treatment, with consideration of getting help being less likely in cities in the border region. We observed no significant differences in treatment receipt across cities. Reduced densities of all three types of treatment programs were significant mediators for the effect of residing in a border region on considering getting help. Time to nearest Spanish-language program also mediated the effect of residing in a border region on considering getting help for one city. CONCLUSIONS Border cities had lower density of treatment and because treatment density was positively associated with considering getting help, residence in a city in the border region was associated with lower odds of considering getting help, regardless of type of treatment. These findings suggest increasing the number of treatment locations available within cities along the U.S.-Mexico border may encourage those with AUD to consider getting help.
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Affiliation(s)
- Kara M K Bensley
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St #450, Emeryville, CA 94062, USA; University of California, Berkeley School of Public Health, 6001 Shellmound St #450, Emeryville, CA 94062, USA.
| | | | - Cheryl Cherpitel
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St #450, Emeryville, CA 94062, USA.
| | - Libo Li
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St #450, Emeryville, CA 94062, USA.
| | - Lynn S Wallisch
- University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd., Austin, TX 78712, USA.
| | - Sarah E Zemore
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St #450, Emeryville, CA 94062, USA; University of California, Berkeley School of Public Health, 6001 Shellmound St #450, Emeryville, CA 94062, USA.
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Tao Z, Cheng Y, Liu J. Hierarchical two-step floating catchment area (2SFCA) method: measuring the spatial accessibility to hierarchical healthcare facilities in Shenzhen, China. Int J Equity Health 2020; 19:164. [PMID: 32957992 PMCID: PMC7507269 DOI: 10.1186/s12939-020-01280-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Spatial accessibility to healthcare facilities has drawn much attention in health geography. In China, central and local governments have aimed to develop a well-organized hierarchical system of healthcare facilities in recent years. However, few studies have focused on the measurement of healthcare accessibility in a hierarchical service delivery system, which is crucial for the assessment and implementation of such strategies. METHODS Based on recent improvements in 2SFCA (two-step floating catchment area) method, this study aims to propose a Hierarchical 2SFCA (H2SFCA) method for measuring spatial accessibility to hierarchical facilities. The method considers the varied catchment area sizes, distance decay effects, and transport modes for facilities at various levels. Moreover, both the relative and absolute distance effects are incorporated into the accessibility measurement. RESULTS The method is applied and tested in a case study of hierarchical healthcare facilities in Shenzhen, China. The results reveal that the general spatial accessibility to hierarchical healthcare facilities in Shenzhen is unevenly distributed and concentrated. The disparity of general accessibility is largely caused by the concentrated distribution of tertiary hospitals. For facilities at higher levels, average accessibility of demanders is higher, but there are also larger disparities in spatial accessibility. The comparison between H2SFCA and traditional methods reveals that traditional methods underestimate the spatial disparity of accessibility, which may lead to biased suggestions for policy making. CONCLUSIONS The results suggest that the supply of healthcare resources at primary facilities is far from sufficient. To improve the spatial equity in spatial accessibility to hierarchical healthcare facilities, various actions are needed at different levels. The proposed H2SFCA method contributes to the modelling of spatial accessibility to hierarchical healthcare facilities in China and similar environments where the referral system has not been well designed. It can also act as the foundation for developing more comprehensive measures in future studies.
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Affiliation(s)
- Zhuolin Tao
- Faculty of Geographical Science, Beijing Normal University, Beijing, 100875 China
- Department of Urban Planning and Design, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Yang Cheng
- Faculty of Geographical Science, Beijing Normal University, Beijing, 100875 China
| | - Jixiang Liu
- Department of Urban Planning and Design, The University of Hong Kong, Pokfulam Road, Hong Kong, China
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Joseph NK, Macharia PM, Ouma PO, Mumo J, Jalang'o R, Wagacha PW, Achieng VO, Ndung'u E, Okoth P, Muñiz M, Guigoz Y, Panciera R, Ray N, Okiro EA. Spatial access inequities and childhood immunisation uptake in Kenya. BMC Public Health 2020; 20:1407. [PMID: 32933501 PMCID: PMC7493983 DOI: 10.1186/s12889-020-09486-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor access to immunisation services remains a major barrier to achieving equity and expanding vaccination coverage in many sub-Saharan African countries. In Kenya, the extent to which spatial access affects immunisation coverage is not well understood. The aim of this study was to quantify spatial accessibility to immunising health facilities and determine its influence on immunisation uptake in Kenya while controlling for potential confounders. METHODS Spatial databases of immunising facilities, road network, land use and elevation were used within a cost friction algorithim to estimate the travel time to immunising health facilities. Two travel scenarios were evaluated; (1) Walking only and (2) Optimistic scenario combining walking and motorized transport. Mean travel time to health facilities and proportions of the total population living within 1-h to the nearest immunising health facility were computed. Data from a nationally representative cross-sectional survey (KDHS 2014), was used to estimate the effect of mean travel time at survey cluster units for both fully immunised status and third dose of diphtheria-tetanus-pertussis (DPT3) vaccine using multi-level logistic regression models. RESULTS Nationally, the mean travel time to immunising health facilities was 63 and 40 min using the walking and the optimistic travel scenarios respectively. Seventy five percent of the total population were within one-hour of walking to an immunising health facility while 93% were within one-hour considering the optimistic scenario. There were substantial variations across the country with 62%(29/47) and 34%(16/47) of the counties with < 90% of the population within one-hour from an immunising health facility using scenarios 1 and 2 respectively. Travel times > 1-h were significantly associated with low immunisation coverage in the univariate analysis for both fully immunised status and DPT3 vaccine. Children living more than 2-h were significantly less likely to be fully immunised [AOR:0.56(0.33-0.94) and receive DPT3 [AOR:0.51(0.21-0.92) after controlling for household wealth, mother's highest education level, parity and urban/rural residence. CONCLUSION Travel time to immunising health facilities is a barrier to uptake of childhood vaccines in regions with suboptimal accessibility (> 2-h). Strategies that address access barriers in the hardest to reach communities are needed to enhance equitable access to immunisation services in Kenya.
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Affiliation(s)
- Noel K Joseph
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.
| | - Peter M Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Paul O Ouma
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jeremiah Mumo
- Health Information System Unit, Ministry of Health, Nairobi, Kenya
| | - Rose Jalang'o
- National Vaccines and Immunization Programme, Ministry of Health, Nairobi, Kenya
| | - Peter W Wagacha
- School of Computing and Informatics, University of Nairobi, Nairobi, Kenya
| | - Victor O Achieng
- Kenya Country Office, The United Nations Children's Fund, Nairobi, Kenya
| | - Eunice Ndung'u
- Kenya Country Office, The United Nations Children's Fund, Nairobi, Kenya
| | - Peter Okoth
- Kenya Country Office, The United Nations Children's Fund, Nairobi, Kenya
| | - Maria Muñiz
- Regional Office for Eastern and Southern Africa, The United Nations Children's Fund, Nairobi, Kenya
| | - Yaniss Guigoz
- GeoHealth group, Institute of Global Health & Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Rocco Panciera
- Health section, The United Nations Children's Fund, New York, USA
| | - Nicolas Ray
- GeoHealth group, Institute of Global Health & Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Emelda A Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LJ, UK
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Kang JY, Michels A, Lyu F, Wang S, Agbodo N, Freeman VL, Wang S. Rapidly measuring spatial accessibility of COVID-19 healthcare resources: a case study of Illinois, USA. Int J Health Geogr 2020; 19:36. [PMID: 32928236 PMCID: PMC7487451 DOI: 10.1186/s12942-020-00229-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/30/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the coronavirus disease 2019 (COVID-19) pandemic, has infected millions of people and caused hundreds of thousands of deaths. While COVID-19 has overwhelmed healthcare resources (e.g., healthcare personnel, testing resources, hospital beds, and ventilators) in a number of countries, limited research has been conducted to understand spatial accessibility of such resources. This study fills this gap by rapidly measuring the spatial accessibility of COVID-19 healthcare resources with a particular focus on Illinois, USA. METHOD The rapid measurement is achieved by resolving computational intensity of an enhanced two-step floating catchment area (E2SFCA) method through a parallel computing strategy based on cyberGIS (cyber geographic information science and systems). The E2SFCA has two major steps. First, it calculates a bed-to-population ratio for each hospital location. Second, it sums these ratios for residential locations where hospital locations overlap. RESULTS The comparison of the spatial accessibility measures for COVID-19 patients to those of population at risk identifies which geographic areas need additional healthcare resources to improve access. The results also help delineate the areas that may face a COVID-19-induced shortage of healthcare resources. The Chicagoland, particularly the southern Chicago, shows an additional need for resources. This study also identified vulnerable population residing in the areas with low spatial accessibility in Chicago. CONCLUSION Rapidly measuring spatial accessibility of healthcare resources provides an improved understanding of how well the healthcare infrastructure is equipped to save people's lives during the COVID-19 pandemic. The findings are relevant for policymakers and public health practitioners to allocate existing healthcare resources or distribute new resources for maximum access to health services.
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Affiliation(s)
- Jeon-Young Kang
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Alexander Michels
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Illinois Informatics Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Fangzheng Lyu
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Shaohua Wang
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Nelson Agbodo
- Division of Health Data and Policy, Illinois Department of Public Health, Springfield, IL, USA
| | - Vincent L Freeman
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Shaowen Wang
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Illinois Informatics Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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Abstract
The increasing inequality in spatial accessibility to hospitals in developing countries has been attracting attention from researchers and politicians. The situation seems to be worse in growing megacities where more than 10 million people live and rapid urban sprawl has caused serious problems with the supply of health and public transport services. The recent global COVID-19 pandemic calls for particular attention to be afforded to the matter of equal access to basic medical facilities and services for people across different neighborhoods. Although some studies have already been undertaken into the subject of health-focused inequality in the cities of developing countries, the spatial inequity in hospital accessibility has rarely been discussed to date. In this paper, I aim to provide new evidence by considering Beijing as a case study. With the results of my analysis, I show that low-income neighborhoods have experienced lower levels of accessibility not only to high-tier hospitals (secondary and tertiary hospitals) but also to primary healthcare services (primary hospital and neighborhood clinics). The rate at which high-income neighborhoods access secondary and tertiary hospitals is approximately 4 times and 1.5 times as high as that of low-income neighborhoods. Low-income face nearly twice the travel time of those from high-income neighborhoods to reach the nearest primary hospital or neighborhood clinics. Suburban neighborhoods have less access to medical services than neighborhoods that are located in the central urban areas. It seems that the rapid urban sprawl has been worsening spatial inequality in the context of access to medical services in the growing megacity of Beijing. Equal access to healthcare services should be prioritized in future policy discussions, especially in relation to the urban growth management of megacities in developing countries in order to ensure that fair and inclusive urbanization processes are undertaken. Equal access to healthcare services would also be widely beneficial in the context of managing the COVID-19 pandemic.
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Affiliation(s)
- Pengjun Zhao
- College of Urban and Environmental Sciences, Peking University, PR China.
| | - Shengxiao Li
- College of Urban and Environmental Sciences, Peking University, PR China.
| | - Di Liu
- College of Urban and Environmental Sciences, Peking University, PR China.
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Hughes AE, Lee SC, Eberth JM, Berry E, Pruitt SL. Do mobile units contribute to spatial accessibility to mammography for uninsured women? Prev Med 2020; 138:106156. [PMID: 32473958 PMCID: PMC7388587 DOI: 10.1016/j.ypmed.2020.106156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 03/18/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
Limited spatial accessibility to mammography, and socioeconomic barriers (e.g., being uninsured), may contribute to rural disparities in breast cancer screening. Although mobile mammography may contribute to population-level access, few studies have investigated this relationship. We measured mammography access for uninsured women using the variable two-step floating catchment area (V2SFCA) method, which estimates access at the local level using estimated potential supply and demand. Specifically, we measured supply with mammography machine certifications in 2014 from FDA and brick-and-mortar and mobile facility data from the community-based Breast Screening and Patient Navigation (BSPAN) program. We measured potential demand using Census tract-level estimates of female residents aged 45-74 from 5-year 2012-2016 American Community Survey data. Using the sign test, we compared mammography access estimates based on 3 facility groupings: FDA-certified, program brick-and-mortar only, and brick-and-mortar plus mobile. Using all mammography facilities, accessibility was high in urban Dallas-Ft. Worth, low for the ring of adjacent counties, and high for rural counties outlying this ring. Brick-and-mortar-based estimates were lower for the outlying ring, and mobile-unit contribution to access was observed more in urban tracts. Weak mobile-unit contribution across the study area may indicate suboptimal dispatch of mobile units to locations. Geospatial methods could identify the optimal locations for mobile units, given existing brick-and-mortar facilities, to increase access for underserved areas.
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Affiliation(s)
- Amy E Hughes
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
| | - Simon C Lee
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Emily Berry
- Moncrief Cancer Center, Fort Worth, TX, USA.
| | - Sandi L Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
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Bauer J, Klingelhöfer D, Maier W, Schwettmann L, Groneberg DA. Prediction of hospital visits for the general inpatient care using floating catchment area methods: a reconceptualization of spatial accessibility. Int J Health Geogr 2020; 19:29. [PMID: 32718317 PMCID: PMC7384227 DOI: 10.1186/s12942-020-00223-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/16/2020] [Indexed: 11/28/2022] Open
Abstract
Background The adequate allocation of inpatient care resources requires assumptions about the need for health care and how this need will be met. However, in current practice, these assumptions are often based on outdated methods (e.g. Hill-Burton Formula). This study evaluated floating catchment area (FCA) methods, which have been applied as measures of spatial accessibility, focusing on their ability to predict the need for health care in the inpatient sector in Germany. Methods We tested three FCA methods (enhanced (E2SFCA), modified (M2SFCA) and integrated (iFCA)) for their accuracy in predicting hospital visits regarding six medical diagnoses (atrial flutter/fibrillation, heart failure, femoral fracture, gonarthrosis, stroke, and epilepsy) on national level in Germany. We further used the closest provider approach for benchmark purposes. The predicted visits were compared with the actual visits for all six diagnoses using a correlation analysis and a maximum error from the actual visits of ± 5%, ± 10% and ± 15%. Results The analysis of 229 million distances between hospitals and population locations revealed a high and significant correlation of predicted with actual visits for all three FCA methods across all six diagnoses up to ρ = 0.79 (p < 0.001). Overall, all FCA methods showed a substantially higher correlation with actual hospital visits compared to the closest provider approach (up to ρ = 0.51; p < 0.001). Allowing a 5% error of the absolute values, the analysis revealed up to 13.4% correctly predicted hospital visits using the FCA methods (15% error: up to 32.5% correctly predicted hospital). Finally, the potential of the FCA methods could be revealed by using the actual hospital visits as the measure of hospital attractiveness, which returned very strong correlations with the actual hospital visits up to ρ = 0.99 (p < 0.001). Conclusion We were able to demonstrate the impact of FCA measures regarding the prediction of hospital visits in non-emergency settings, and their superiority over commonly used methods (i.e. closest provider). However, hospital beds were inadequate as the measure of hospital attractiveness resulting in low accuracy of predicted hospital visits. More reliable measures must be integrated within the proposed methods. Still, this study strengthens the possibilities of FCA methods in health care planning beyond their original application in measuring spatial accessibility.
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Affiliation(s)
- J Bauer
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany.
| | - D Klingelhöfer
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - W Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - L Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Department of Economics, Martin Luther University Halle-Wittenberg, 06099, Halle an der Saale, Germany
| | - D A Groneberg
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
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Stewart K, Li M, Xia Z, Adewole SA, Adeyemo O, Adebamowo C. Modeling spatial access to cervical cancer screening services in Ondo State, Nigeria. Int J Health Geogr 2020; 19:28. [PMID: 32693815 PMCID: PMC7374833 DOI: 10.1186/s12942-020-00222-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Women in low- and middle-income countries (LMIC) remain at high risk of developing cervical cancer and have limited access to screening programs. The limits include geographical barriers related to road network characteristics and travel behaviors but these have neither been well studied in LMIC nor have methods to overcome them been incorporated into cervical cancer screening delivery programs. METHODS To identify and evaluate spatial barriers to cervical cancer prevention services in Ondo State, Nigeria, we applied a Multi-Mode Enhanced Two-Step Floating Catchment Area model to create a spatial access index for cervical cancer screening services in Ondo City and the surrounding region. The model used inputs that included the distance between service locations and population centers, local population density, quantity of healthcare infrastructures, modes of transportation, and the travel time budgets of clients. Two different travel modes, taxi and mini bus, represented common modes of transit. Geocoded client residential locations were compared to spatial access results to identify patterns of spatial access and estimate where gaps in access existed. RESULTS Ondo City was estimated to have the highest access in the region, while the largest city, Akure, was estimated to be in only the middle tier of access. While 73.5% of clients of the hospital in Ondo City resided in the two highest access zones, 21.5% of clients were from locations estimated to be in the lowest access catchment, and a further 2.25% resided outside these limits. Some areas that were relatively close to cervical cancer screening centers had lower access values due to poor road network coverage and fewer options for public transportation. CONCLUSIONS Variations in spatial access were revealed based on client residential patterns, travel time differences, distance decay assumptions, and travel mode choices. Assessing access to cervical cancer screening better identifies potentially underserved locations in rural Nigeria that can inform plans for cervical cancer screening including new or improved infrastructure, effective resource allocation, introduction of service options for areas with lower access, and design of public transportation networks.
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Affiliation(s)
- Kathleen Stewart
- Department of Geographical Sciences, Center for Geospatial Information Science, University of Maryland, College Park, MD, USA, 20742.
| | - Moying Li
- Department of Geographical Sciences, Center for Geospatial Information Science, University of Maryland, College Park, MD, USA, 20742
| | - Zhiyue Xia
- Department of Geographical Sciences, Center for Geospatial Information Science, University of Maryland, College Park, MD, USA, 20742
| | - Stephen Ayodele Adewole
- Department of Obstetrics and Gynaecology, University of Medicine Teaching Hospital, Ondo, Nigeria
| | | | - Clement Adebamowo
- Department of Epidemiology and Public Health and Greenebaum Comprehensive Cancer Center, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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Shen C, Zhou Z, Lai S, Lu L, Dong W, Su M, Zhang J, Wang X, Deng Q, Chen Y, Chen X. Measuring spatial accessibility and within-province disparities in accessibility to county hospitals in Shaanxi Province of Western China based on web mapping navigation data. Int J Equity Health 2020; 19:99. [PMID: 32552715 PMCID: PMC7302366 DOI: 10.1186/s12939-020-01217-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Chinese government proposed the "XIAO BING BU CHU CUN, DA BING BU CHU XIAN" initiative in 2016, which states the rate of health care service provided by county hospitals should reach 90% of overall health care service provision. The prerequisite for achieving this goal is that citizens should be able to access county hospitals' services conveniently and impartially. However, little research has been done on the actual levels of the spatial accessibility of citizens to county hospitals in Western China. Therefore, we aimed to measure the spatial accessibility to county hospitals for county residents and to identify any regional disparities in Shaanxi Province in Western China. METHODS We implemented a novel method - involving utilizing navigation data from the AutoNavi web mapping system (knows as Gaode map in Chinese) - to assess the time and distance from villages and neighborhoods to the county hospitals. The navigation data were collected by request through an application-programming-interface using a web crawler (web data extraction tool) in Python. The shortest driving time and distance were extracted from the navigation data. The travel impedance to the nearest provider (TINP) indicator was used to measure spatial accessibility. RESULTS The results show that county residents in Western China's Shaanxi Province have poor spatial accessibility to county hospitals. Only 68.8% of villages and neighborhoods are within 60 min travel time (based on driving mode) to a county hospital, while 13.4% of such villages and neighborhoods are beyond 90 min travel time. Moreover, a significant within-province disparity exists, with residents in the central area enjoying the best accessibility to county hospitals, while the northern and southern areas still need improvements in accessibility. CONCLUSIONS Focused health resource planning is required to improve the spatial accessibility to county hospitals and to eliminate regional disparities. Further studies are called for to integrate the navigation data of web mapping systems with GIS methods to the measure spatial accessibility of health facilities in more complex contexts.
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Affiliation(s)
- Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, No.28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, No.28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, No.28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Li Lu
- Team IETO, Bordeaux Population Health Research Center, University de Bordeaux, 33076, Bordeaux, France
| | - Wanyue Dong
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710063, China
| | - Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, 010021, China
| | - Jian Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, No.28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Xinyu Wang
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710063, China
| | - Qiwei Deng
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710063, China
| | - Yaru Chen
- Centre for HealthCare Innovation Research, Cass Business School & School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, 06520, USA
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Shrestha S, Kestens Y, Thomas F, El Aarbaoui T, Chaix B. Spatial access to sport facilities from the multiple places visited and sport practice: Assessing and correcting biases related to selective daily mobility. Soc Sci Med 2019; 236:112406. [PMID: 31336218 DOI: 10.1016/j.socscimed.2019.112406] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 07/03/2019] [Accepted: 07/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Studies investigating the association between spatial accessibility to environmental resources from the various places a person visits during daily activities and use of corresponding resources often do not account for potential biases related to selective daily mobility. This bias occurs when accessibility is also measured from places intentionally visited to access the resources of interest. The aim of this study was to examine associations between spatial accessibility to sports facilities from multiple places and sport practice while addressing the selective daily mobility bias. METHODS The second wave of the RECORD Cohort was used to examine the relationship between the spatial accessibility to sport facilities and the practice of three sport categories (swimming, racket, and team sports), using multilevel linear probability models (n = 5327 participants) adjusted for individual and contextual characteristics. Street network distance to the nearest sport facility was considered as a measure of spatial accessibility [from the residence; from the residence and workplace; from all visited locations (full activity space), biased; and from all locations excluded those visited for sports (truncated activity space), corrected]. RESULTS The residential and residential-workplace accessibility to facilities was not associated with sport practice. The spatial accessibility to facilities from all places visited (full activity space) was associated with the practice of the three categories of sports (biased relationships). After correcting the bias (truncated activity space), the strength of the relationships was markedly reduced. An association remained only for swimming sports. CONCLUSION This study underlines the need to account for selective daily mobility bias when determining spatial accessibility to resources from the various places visited. Such bias, if not addressed, may result in overestimated associations between spatial accessibility and use, leading to potentially erroneous conclusions in terms of planning.
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Affiliation(s)
- Samjhana Shrestha
- Inserm, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Nemesis Team, Paris, France; Sorbonne Université, Univ Paris 06, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Nemesis Team, Paris, France; School of Health and Related Research, The University of Sheffield, Sheffield, UK; EHESP School of Public Health, Paris, France.
| | - Yan Kestens
- Department of Social and Preventive Medicine, The University of Montreal, Montreal, Canada
| | - Frédérique Thomas
- Centre d'Investigations Préventives et Cliniques, 6 rue La Pérouse, 75116 Paris, France
| | - Tarik El Aarbaoui
- Inserm, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Nemesis Team, Paris, France
| | - Basile Chaix
- Inserm, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Nemesis Team, Paris, France
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Mudd AE, Michael YL, Melly S, Moore K, Diez-Roux A, Forrest CB. Spatial accessibility to pediatric primary care in Philadelphia: an area-level cross sectional analysis. Int J Equity Health 2019; 18:76. [PMID: 31126295 PMCID: PMC6534862 DOI: 10.1186/s12939-019-0962-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/16/2019] [Indexed: 11/25/2022] Open
Abstract
Background Pediatric primary care visits are a foundational element in the health maintenance of children. Differential access may be a driver of racial inequities in health. We hypothesized that pediatric primary care accessibility would be lowest in neighborhoods with higher proportion of non-Hispanic Black residents. Methods Annual ratios (2008–2016) of providers to pediatric population were calculated by census tract in Philadelphia, Pennsylvania. Marginal logistic regression was used to estimate the independent association between neighborhood racial composition and access to pediatric primary care controlling for confounders. Results In general, low access to care was associated with greater neighborhood disadvantage (e.g., SES, % poverty, % public insurance). After controlling for neighborhood indicators of disadvantage, risk of being in the lowest quintile of access significantly increased as the percent of non-Hispanic Black residents increased. Conclusion A new measure of pediatric primary care accessibility demonstrates a persistent disparity in primary care access for predominantly non-Hispanic Black neighborhoods.
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Affiliation(s)
- Abigail E Mudd
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA.
| | - Yvonne L Michael
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Steven Melly
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Kari Moore
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Ana Diez-Roux
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Christopher B Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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Cao Y, Stewart K, Wish E, Artigiani E, Sorg MH. Determining spatial access to opioid use disorder treatment and emergency medical services in New Hampshire. J Subst Abuse Treat 2019; 101:55-66. [PMID: 31174714 DOI: 10.1016/j.jsat.2019.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/14/2019] [Accepted: 03/29/2019] [Indexed: 01/04/2023]
Abstract
This research presents an analysis of spatial access to both opioid use disorder treatment facilities and emergency medical services in New Hampshire during 2015-2016, a period during which there was a steep increase in unintentional overdoses involving fentanyl. For this research, spatial access was computed using the enhanced two-step floating catchment area model combined with the Huff model to assess access across New Hampshire and gives attention to supply-side parameters that can impact spatial access. The model is designed to measure access to healthcare services for opioid use disorder patients offered at treatment centers or from buprenorphine treatment practitioners, as well as from emergency medical services across New Hampshire. A composite index of accessibility is proposed to represent overall access to these different treatment services for opioid use disorder patients. Geospatial determinants of spatial access included street network distances, driving times and distance decay relationships, while other key factors were services availability and population demand. Among the towns with the highest composite access scores, approximately 40% were metropolitan locations while 16% were rural towns. The insights from this research showed that for this period, while the opioid crisis was impacting many towns in New Hampshire, high levels of access to treatment services were not uniform across the state. When comparing the access results with data on the towns of residence for individuals who died from unintentional overdoses involving fentanyl during 2015 and 2016, estimates found that approximately 40% of the towns were not estimated to be in the highest class of access to treatment services at the time. This research provides information for local public health officials to support planning strategies to address opioid use disorder treatment access in high-risk regions.
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Affiliation(s)
- Yanjia Cao
- Center for Geospatial Information Science, University of Maryland, College Park, MD 20742, United States of America; Department of Geographical Sciences, University of Maryland, College Park, MD 20742, United States of America.
| | - Kathleen Stewart
- Center for Geospatial Information Science, University of Maryland, College Park, MD 20742, United States of America; Department of Geographical Sciences, University of Maryland, College Park, MD 20742, United States of America
| | - Eric Wish
- Center for Substance Abuse Research, University of Maryland, College Park, MD 20740, United States of America
| | - Eleanor Artigiani
- Center for Substance Abuse Research, University of Maryland, College Park, MD 20740, United States of America
| | - Marcella H Sorg
- Margaret Chase Smith Policy Center, University of Maine, Orono, ME 04469, United States of America
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Delamater PL, Shortridge AM, Kilcoyne RC. Using floating catchment area (FCA) metrics to predict health care utilization patterns. BMC Health Serv Res 2019; 19:144. [PMID: 30832628 PMCID: PMC6399985 DOI: 10.1186/s12913-019-3969-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Floating Catchment Area (FCA) metrics provide a comprehensive measure of potential spatial accessibility to health care services and are often used to identify geographic disparities in health care access. An unexplored aspect of FCA metrics is whether they can be useful in predicting where people actually seek care. This research addresses this question by examining the utility of FCA metrics for predicting patient utilization patterns, the flows of patients from their residences to facilities. METHODS Using more than one million inpatient hospital visits in Michigan, we calculated expected utilization patterns from Zip Codes to hospitals using four FCA metrics and two traditional metrics (simple distance and a Huff model) and compared them to observed utilization patterns. Because all of the accessibility metrics rely on the specification of a distance decay function and its associated parameters, we conducted a sensitivity analysis to evaluate their effects on prediction accuracy. RESULTS We found that the Three Step FCA (3SFCA) and Modified Two Step FCA (M2SFCA) were the most effective metrics for predicting utilization patterns, correctly predicting the destination hospital for nearly 74% of hospital visits in Michigan. These two metrics were also the least sensitive to changes to the distance decay functions and parameter settings. CONCLUSIONS Overall, this research demonstrates that FCA metrics can provide reasonable predictions of patient utilization patterns and FCA utilization models could be considered as a substitute when utilization pattern data are unavailable.
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Affiliation(s)
- Paul L. Delamater
- Department of Geography and the Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Ashton M. Shortridge
- Department of Geography, Environment, and Spatial Sciences, Michigan State University, East Lansing, MI 48824 USA
| | - Rachel C. Kilcoyne
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, VA 22030 USA
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Calovi M, Seghieri C. Using a GIS to support the spatial reorganization of outpatient care services delivery in Italy. BMC Health Serv Res 2018; 18:883. [PMID: 30466428 PMCID: PMC6249902 DOI: 10.1186/s12913-018-3642-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/23/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Studying and measuring accessibility to care services has become a major concern for health care management, particularly since the global financial collapse. This study focuses on Tuscany, an Italian region, which is re-organizing its inpatient and outpatient systems in line with new government regulations. The principal aim of the paper is to illustrate the application of GIS methods with real-world scenarios to provide support to evidence-based planning and resource allocation in healthcare. METHODS Spatial statistics and geographical analyses were used to provide health care policy makers with a real scenario of accessibility to outpatient clinics. Measures for a geographical potential spatial accessibility index using the two-step floating catchment area method for outpatient services in 2015 were calculated and used to simulate the rationalization and reorganization of outpatient services. Parameters including the distance to outpatient clinics and volumes of activity were taken into account. RESULTS The spatial accessibility index and the simulation of reorganization in outpatient care delivery are presented through three cases, which highlight three different managerial strategies. The results revealed the municipalities where health policy makers could consider a new spatial location, a shutdown or combining selected outpatient clinics while ensuring equitable access to services. CONCLUSIONS A GIS-based approach was designed to provide support to healthcare management and policy makers in defining evidence-based actions to guide the reorganization of a regional health care delivery system. The analysis provides an example of how GIS methods can be applied to an integrated framework of administrative health care and geographical data as a valuable instrument to improve the efficiency of healthcare service delivery, in relation to the population's needs.
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Affiliation(s)
- Martina Calovi
- Geoinformatics and Earth Observation Laboratory, Department of Geography and Institute for CyberScience, The Pennsylvania State University, University Park, PA USA
| | - Chiara Seghieri
- Management and Healthcare Lab, Institute of Management, Sant’Anna School of Advanced Studies, Piazza Martiri della Libertà, 24, 56127 Pisa, Italy
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Mathon D, Apparicio P, Lachapelle U. Cross-border spatial accessibility of health care in the North-East Department of Haiti. Int J Health Geogr 2018; 17:36. [PMID: 30359261 PMCID: PMC6203203 DOI: 10.1186/s12942-018-0156-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 10/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The geographical accessibility of health services is an important issue especially in developing countries and even more for those sharing a border as for Haiti and the Dominican Republic. During the last 2 decades, numerous studies have explored the potential spatial access to health services within a whole country or metropolitan area. However, the impacts of the border on the access to health resources between two countries have been less explored. The aim of this paper is to measure the impact of the border on the accessibility to health services for Haitian people living close to the Haitian-Dominican border. METHODS To do this, the widely employed enhanced two-step floating catchment area (E2SFCA) method is applied. Four scenarios simulate different levels of openness of the border. Statistical analysis are conducted to assess the differences and variation in the E2SFCA results. A linear regression model is also used to predict the accessibility to health care services according to the mentioned scenarios. RESULTS The results show that the health professional-to-population accessibility ratio is higher for the Haitian side when the border is open than when it is closed, suggesting an important border impact on Haitians' access to health care resources. On the other hand, when the border is closed, the potential accessibility for health services is higher for the Dominicans. CONCLUSION The openness of the border has a great impact on the spatial accessibility to health care for the population living next to the border and those living nearby a road network in good conditions. Those findings therefore point to the need for effective and efficient trans-border cooperation between health authorities and health facilities. Future research is necessary to explore the determinants of cross-border health care and offers an insight on the spatial revealed access which could lead to a better understanding of the patients' behavior.
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Affiliation(s)
- Dominique Mathon
- Environmental Equity Laboratory, INRS Centre Urbanisation Culture Société, 385, rue Sherbrooke Est, Montréal, Québec, H2X 1E3, Canada
| | - Philippe Apparicio
- Environmental Equity Laboratory, INRS Centre Urbanisation Culture Société, 385, rue Sherbrooke Est, Montréal, Québec, H2X 1E3, Canada.
| | - Ugo Lachapelle
- Département d'études urbaines et touristiques, Université du Québec à Montréal, Case postale 8888, Succursale Centre-Ville, Montréal, Québec, H3C 3P8, Canada
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Lu H, Zhang X, Holt JB, Kanny D, Croft JB. Quantifying spatial accessibility in public health practice and research: an application to on-premise alcohol outlets, United States, 2013. Int J Health Geogr 2018; 17:23. [PMID: 29945619 PMCID: PMC6020393 DOI: 10.1186/s12942-018-0143-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/19/2018] [Indexed: 01/12/2023] Open
Abstract
Objective To assess spatial accessibility measures to on-premise alcohol outlets at census block, census tract, county, and state levels for the United States. Methods Using network analysis in a geographic information system, we computed distance-based measures (Euclidean distance, driving distance, and driving time) to on-premise alcohol outlets for the entire U.S. at the census block level. We then calculated spatial access-based measures, specifically a population-weighted spatial accessibility index and population-weighted distances (Euclidean distance, driving distance, and driving time) to alcohol outlets at the census tract, county, and state levels. A multilevel model-based sensitivity analysis was conducted to evaluate the associations between different on-premise alcohol outlet accessibility measures and excessive drinking outcomes. Results The national average population-weighted driving time to the nearest 7 on-premise alcohol outlets was 5.89 min, and the average population-weighted driving distance was 2.63 miles. At the state level, population-weighted driving times ranged from 1.67 min (DC) to 15.29 min (Arizona). Population-weighted driving distances ranged from 0.67 miles (DC) to 7.91 miles (Arkansas). At the county level, population-weighted driving times and distances exhibited significant geographic variations, and averages for both measures increased by the degree of county rurality. The population-weighted spatial accessibility indexes were highly correlated to respective population-weighted distance measures. Sensitivity analysis demonstrated that population weighted accessibility measures were more sensitive to excessive drinking outcomes than were population weighted distance measures. Conclusions These results can be used to assess the relationship between geographic access to on-premise alcohol outlets and health outcomes. This study demonstrates a flexible and robust method that can be applied or modified to quantify spatial accessibility to public resources such as healthy food stores, medical care providers, and parks and greenspaces, as well as, quantify spatial exposure to local adverse environments such as tobacco stores and fast food restaurants. Electronic supplementary material The online version of this article (10.1186/s12942-018-0143-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hua Lu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, N.E. Mailstop F-78, Atlanta, GA, 30341, USA.
| | - Xingyou Zhang
- Economic Research Service, U.S. Department of Agriculture, Washington, DC, USA
| | - James B Holt
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, N.E. Mailstop F-78, Atlanta, GA, 30341, USA
| | - Dafna Kanny
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, N.E. Mailstop F-78, Atlanta, GA, 30341, USA
| | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, N.E. Mailstop F-78, Atlanta, GA, 30341, USA
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Tao Z, Cheng Y, Zheng Q, Li G. Measuring spatial accessibility to healthcare services with constraint of administrative boundary: a case study of Yanqing District, Beijing, China. Int J Equity Health 2018; 17:7. [PMID: 29334979 PMCID: PMC5769485 DOI: 10.1186/s12939-018-0720-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The two-step floating catchment area (2SFCA) method, which is one of the most widely used methods for measuring healthcare spatial accessibility, defines the catchment area of each facility as the area within a certain distance from the facility. However, in some cases, the service utilization behavior is constrained by administrative boundaries, therefore the definition of catchment area within a certain distance may be inappropriate. METHODS In this study, we aim to propose a modification of the 2SFCA method for measuring spatial accessibility to healthcare services in a system constrained by administrative boundaries. The proposed method defines the catchment areas of healthcare facilities within certain administrative units. The method is applied in a case study of the healthcare services in Yanqing District of Beijing, China. Three types of healthcare facilities, including general hospitals, community healthcare centers and stations, are included. RESULTS Based on the sensitivity analysis of the distance-decay parameter β, result of the β = 1 scenario is relatively appropriate and is utilized for further analysis. The difference between spatial accessibility with or without constraint of administrative boundary is relatively significant. The results of the proposed model show that the village-level spatial accessibility to healthcare services shows a significant disparity, and the uneven distribution of general hospitals is the main cause. CONCLUSIONS The constraint of administrative boundary has a significant impact on healthcare accessibility, which verifies the validity of the modification proposed by this study in empirical studies. The empirical results also lead to policy recommendations to improve healthcare equity in the study area. At the town-level, the improvement of equity in healthcare accessibility could be achieved in two ways. First, the sizes of community healthcare centers in towns with small accessibility scores should be expanded. Second, new general hospitals can be built in the eastern part of Yanqing District. Within each town, to improve the equity in healthcare accessibility, community healthcare stations should be expanded or newly built in the periphery villages.
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Affiliation(s)
- Zhuolin Tao
- College of Urban and Environmental Sciences, Peking University, Beijing, 100871 China
- School of Urban Planning and Design, Peking University, Shenzhen, Guangdong 518055 China
| | - Yang Cheng
- School of Geography, Faculty of Geographical Science, Beijing Normal University, 19 Xinjiekouwai Street, Haidian, Beijing, 100875 China
| | - Qingjing Zheng
- China Academy of Urban Planning and Design Shenzhen, Shenzhen, Guangdong 518034 China
| | - Guicai Li
- School of Urban Planning and Design, Peking University, Shenzhen, Guangdong 518055 China
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