The geographic alignment of primary care Health Professional Shortage Areas with markers for social determinants of health

Abstract

Background The Health Resources and Services Administration (HRSA), an agency within the U.S. Department of Health and Human Services (HHS), works to ensure accessible, quality, health care for the nation's underserved populations, especially those who are medically, economically, or geographically vulnerable. HRSA-designated primary care Health Professional Shortage Areas (pcHPSAs) provide a vital measure by which to identify underserved populations and prioritize locations and populations lacking access to adequate primary and preventive health care-the foundation for advancing health equity and maintaining health and wellness for individuals and populations. However, access to care is a complex, multifactorial issue that involves more than just the number of health care providers available, and pcHPSAs alone cannot fully characterize the distribution of medically, economically, and geographically vulnerable populations. Methods and findings In this county-level analysis, we used descriptive statistics and multiple correspondence analysis to assess how HRSA's pcHPSA designations align geographically with other established markers of medical, economic, and geographic vulnerability. Reflecting recognized social determinants of health (SDOH), markers included demographic characteristics, race and ethnicity, rates of low birth weight births, median household income, poverty, educational attainment, and rurality. Nationally, 96 percent of U.S. counties were either classified as whole county or partial county pcHPSAs or had one or more established markers of medical, economic, or geographic vulnerability in 2017, suggesting that at-risk populations were nearly ubiquitous throughout the nation. Primary care HPSA counties in HHS Regions 4 and 6 (largely lying within the southeastern and south central United States) had the most pervasive and complex patterns in population risk.

Eviction, Health Inequity, and the Spread of COVID-19: Housing Policy as a Primary Pandemic Mitigation Strategy

“…Eviction may also lead to lower access to COVID-19 testing [40] and medical attention by driving families to poorer, underresourced neighborhoods, and medically underserved geographic areas with fewer medical facilities and providers, in addition to decreased care affordability [41]. Even when infected individuals present with COVID-19 symptoms, eviction decreases the likelihood that they will seek timely medical attention that could stem community transmission [20].…”

Associations Between Primary Care Provider Shortage Areas and County-Level COVID-19 Infection and Mortality Rates in the USA

“…It is also possible that these areas face other, unmeasured medical, economic, and social makers of vulnerability. 2 Further research should track these findings over time and seek to disaggregate the possible underlying mechanisms. Regardless of the causal pathway, the findings suggest that many communities are likely to face simultaneous challenges of high burden of coronavirus, social and economic disadvantage, and limited access to primary medical care.…”

Determinants of rural-urban differences in health care provider visits among women of reproductive age in the United States

“…Based on prior studies of women’s health care access and health disparities, individual-level predictors were selected as covariates, including age, race, ethnicity, educational status, marital status, family income, health insurance status, family size, employment status, pregnancy status, U.S. Census region, and self-perceived poor or fair general and mental health status [ 1 , 6 , 7 , 15 , 21 , 28 ]. Also, using prior studies for guidance, key county-level characteristics from the AHRF were selected, including unemployment rates and the number of obstetrics-gynecology physicians, non-subspecialist primary care physicians, nurse practitioners, and physician assistants per 100,000 population [ 1 , 7 , 16 , 21 ].…”

“…There are disproportionate regional shortages of OB-GYNs and primary care physicians across the nation, health workforce deficiencies that are projected by the federal Health Resources and Services Administration (HRSA) to worsen in coming years [ 13 , 14 ]. Provider shortages often coexist in rural communities with prevalent, adverse social determinants of health that serve to increase maternal mortality risk [ 6 , 15 ]. The importance of understanding and addressing differences in women’s health care access is further underscored by rising rates of severe maternal morbidity and mortality and increasing hospital obstetric unit closures in rural areas with noted consequences for birth outcomes [ 4 , 16 ].…”