Racial disparities in travel time to radiotherapy facilities in the Atlanta metropolitan area

Abstract

Low-income women with breast cancer who rely on public transportation may have difficulty in completing recommended radiation therapy due to inadequate access to radiation facilities. Using a geographic information system (GIS) and network analysis we quantified spatial accessibility to radiation treatment facilities in the Atlanta, Georgia metropolitan area. We built a transportation network model that included all bus and rail routes and stops, system transfers and walk and wait times experienced by public transportation system travelers. We also built a private transportation network to model travel times by automobile. We calculated travel times to radiation therapy facilities via public and private transportation from a population-weighted center of each census tract located within the study area. We broadly grouped the tracts by low, medium and high household access to a private vehicle and by race. Facility service areas were created using the network model to map the extent of areal coverage at specified travel times (30, 45 and 60 min) for both public and private modes of transportation. The median public transportation travel time to the nearest radiotherapy facility was 56 min vs. approximately 8 min by private vehicle. We found that majority black census tracts had longer public transportation travel times than white tracts across all categories of vehicle access and that 39% of women in the study area had longer than 1 h of public transportation travel time to the nearest facility. In addition, service area analyses identified locations where the travel time barriers are the greatest. Spatial inaccessibility, especially for women who must use public transportation, is one of the barriers they face in receiving optimal treatment.

Geographic Access to Cancer Care and Mortality Among Adolescents

“…49–51 This is consistent with our finding that blacks without Hispanic ethnicity and persons with Hispanic ethnicity had the highest death rate in the zone closest to a COG institution, Zone A, whereas death rates among whites without Hispanic ethnicity did not differ by zone. In contrast to these indicators of vulnerability are the relatively high median income and very high primary physician access in Zone A.…”

“…Public transportation, when available, adds considerably to the time and effort involved in accessing medical care. 49–51 Moreover, access to specialist care can be hampered by lack of insurance or insurance that the specialist does not accept. 57,58 The net result in Zone A is a large population with a more limited attachment to the healthcare system than would be expected given the preponderance of primary physicians and the presence of COG institutions.…”

Association Between Geographic Access to Cancer Care and Receipt of Radiation Therapy for Rectal Cancer

“…6 Studies have demonstrated, however, that radiation oncologists are geographically maldistributed across the nation, 7, 8 clustered at academic centers 7 and of limited accessibility relative to other oncology specialists. 9 Traveling long distances to cancer care is a barrier to cancer treatment, 10–12 associated with decreased utilization of RT, 13–15 or worse treatment outcome. 16 Even with data on association between geographic access and receipt of RT, there is limited information specific to rectal cancer.…”

Use of geographical information systems for delimiting health service areas in China

“…There are three main methods to delimit trade areas: the analogy method (Applebaum, 1965(Applebaum, , 1966Erickson and Finkler, 1985), the proximal area method (Okabe et al, 2008;Peipins, 2013;Guerrero and Kao, 2013) and the gravity method (Huff, 1963(Huff, , 1964. The analogy method is non-geographic and often implemented by regression analysis as first proposed by Applebaum (1965Applebaum ( , 1966.…”