Disparities in accessibility to evidence‐based breast cancer care facilities by rural and urban areas in Bavaria, Germany

Abstract

BACKGROUND: Breast cancer (BC), which is most common in elderly women, requires a multidisciplinary and continuous approach to care. With demographic changes, the number of patients with chronic diseases such as BC will increase. This trend will especially hit rural areas, where the majority of the elderly live, in terms of comprehensive health care. METHODS: Accessibility to several cancer facilities in Bavaria, Germany, was analyzed with a geographic information system. Facilities were identified from the national BC guideline and from 31 participants in a proof-of-concept study from the Breast Cancer Care for Patients With Metastatic Disease registry. The timeframe for accessibility was defined as 30 or 60 minutes for all population points. The collection of address information was performed with different sources (eg, a physician registry). Routine data from the German Census 2011 and the population-based Cancer Registry of Bavaria were linked at the district level. RESULTS: Females from urban areas (n = 2,938,991 [ie, total of females living in urban areas]) had a higher chance for predefined accessibility to the majority of analyzed facilities in comparison with females from rural areas (n = 3,385,813 [ie, total number of females living in rural areas]) with an odds ratio (OR) of 9.0 for cancer information counselling, an OR of 17.2 for a university hospital, and an OR of 7.2 for a psycho-oncologist. For (inpatient) rehabilitation centers (OR, 0.2) and genetic counselling (OR, 0.3), women from urban areas had lower odds of accessibility within 30 or 60 minutes. CONCLUSIONS: Disparities in accessibility between rural and urban areas exist in Bavaria. The identification of underserved areas can help to inform policymakers about disparities in comprehensive health care. Future strategies are needed to deliver high-quality health care to all inhabitants, regardless of residence.

Risk and space: modelling the accessibility of stroke centers using day- & nighttime population distribution and different transportation scenarios

“…The ability to clearly locate specific population groups provides the opportunity to identify risk areas in preventive research. The effects of different population distributions reinforce previous findings on inequality in medical care [ 28 , 53 ]. Thus, we show that a multitemporal view of the population distribution can produce variations in the accessibility situation in the same way as the use of different speed scenarios.…”

“…Neis et al [ 41 ] mention the dataset is becoming comparable in quality to other geodata from commercial providers (also see [ 11 , 51 ]) especially in countries with active communities like in Germany. The successful usage of OSM has been demonstrated for accessibility analyses [ 42 , 46 , 53 , 66 ]. The influence of one-way streets was also be considered with the help of the data.…”

Equivalence of care? Accessibility and availability of dialysis services for older prisoners in Switzerland

“…While population data were obtained through a University license, the remaining databases were open source. Data's suitability for analyzing accessibility of services has been sufficiently demonstrated in other work (Neumeier, 2016;Rauch and Rauh, 2016;Wieland, 2018;Helbich and Amelunxen, 2012;Stangl et al, 2021).…”

A true choice of place of birth? Swiss women’s access to birth hospitals and birth centers

“…Apart from (1) which could be utilized through a University license, the remaining databases were open source and did not require any permission. The suitability of these data has been demonstrated in comparable research [ 29 – 31 ].…”