The following is a summary of “Geographic Disparities in Access to Neurologists and Multiple Sclerosis Care in the United States,” published in the December 2023 issue of Neurology by McGinley et al.

Researchers performed a retrospective study to dissect disparities in geographic access to neurologists and subspecialty multiple sclerosis (MS) care across diverse demographics in the US.

They employed 2022 CMS Care Compare physician data and MS Center locations, as defined by the Consortium of MS Centers, to assess neurologist practice locations in all U.S. census tracts. Census tract-level community features, such as demographics, education, income, and health-related factors, were gathered from the 2020 American Community Survey. Rural-urban status was determined using 2010 commuting area codes. Utilizing logistic and linear regression models, access to a neurologist or an MS Center within a 60-mile radius and 60-mile spatial access ratios was examined.

The results showed 70,858 census tracts, 388 lacking neurologists within a 60-mile radius, while 17,837 had no MS centers within the same distance. Rural (−80.49%; CI [−81.65 to −79.30]) and micropolitan (−60.50%; CI [−62.40 to −58.51]) areas exhibited lower geographic access to neurologists compared to metropolitan areas. Neurologist access was reduced in tracts with a 10% higher percentage of Hispanic individuals (−4.53%; CI [−5.23 to −3.83]), men (−6.76%; CI [−8.96 to −4.5]), uninsured individuals (−7.99%; CI [−9.72 to −6.21]), those with hearing difficulty (−40.72%; CI [−44.62 to −36.54]), vision difficulty (−13.0%; [−18.72 to −6.89]), and ambulatory difficulty (−15.68%; CI [−19.25 to −11.95]). Conversely, tracts with a 10% higher proportion of Black individuals (3.50%; CI [2.93–10.71]), college degree holders (−7.49%; CI [6.67–8.32]), individuals with computers (16.57%, CI [13.82–19.40]), those without a vehicle (9.57%; CI [8.69–10.47]), individuals with cognitive difficulty (25.63%; CI [19.77–31.78]), individuals with limited English (18.5%; CI [16.30–20.73]), and those 10 years older (8.85%; CI [7.03–10.71]) had higher spatial access to neurologists. Similar patterns were observed for covariates influencing MS center access.

They concluded that the study found stark geographic disparities: rural, Hispanic, disabled, and uninsured faced limited neurologist access, with MS care even scarcer.

Source: neurology.org/doi/10.1212/WNL.0000000000207916