Pharmacy Closures Disproportionately Affect Vulnerable Americans
Columbus, OH—How do so-called pharmacy deserts disproportionately affect U.S. residents living in regions with low healthcare practitioner supply and high social vulnerability?
That was the question raised in a recent research letter published in the Journal of the American Medical Association Network Open. “Retail pharmacy chains have been closing thousands of locations throughout the US, possibly playing a role in health care gaps,” the Ohio State University authors wrote. “Similar to the concept of food deserts, areas in which medications are harder to obtain have been deemed pharmacy deserts.”
The study team sourced data through 2020 from TelePharm Map on communities located 10 or more miles from the nearest retail pharmacy. Counties were stratified as high pharmacy desert density if the number of pharmacy deserts per 1,000 inhabitants was in the 80th percentile or higher.
At the same time, the researchers obtained social vulnerability index (SVI) and healthcare practitioner data from the Agency for Toxic Substances and Disease Registry and the Area Health Resources File.
The study calculated the density of primary care practitioners (PCPs; including family medicine, general practice, general internal medicine, general pediatrics physicians) as the number of PCP per 10,000 inhabitants.
The results indicated that, among 3,143 counties reviewed, 1,447 (46%) had at least one pharmacy desert, of which 818 (56.5%) were categorized as having low and 629 (43.5%) as having high pharmacy desert density, respectively.
“Counties with a high vs. low pharmacy desert density had a higher SVI (high SVI: 238 [38.0%] vs. 294 [36.0%]; low SVI: 194 [31.0%] vs 246 [30.0%]; P = .006),” according to the article. “Areas with a high pharmacy desert density had lower median [IQR (interquartile)] PCP density (3.65 [1.12-5.96]) vs. regions with low (5.01 [3.21-7.53]) or no pharmacy (4.86 [3.10-7.40) desert density (P <.001).”
On multivariate analysis, after controlling for age and sex, the researchers determined that both high SVI (odds ratio [OR], 1.35; 95% CI, 1.07-1.70; P = .01) and low PCP density (OR, 2.27; 95% CI, 1.80-2.86; P <.001) were associated with a higher likelihood for a county to have a high pharmacy desert density.
“In the U.S. CVS announced plans to close 900 stores in the next 3 years, and Rite Aid filed for bankruptcy,” the authors wrote. “As pharmacies close, more and more individuals are left without easy access to medications, with disproportionate consequences for certain communities. Patients in higher SVI counties with a lower PCP density had a 30% to 40% higher likelihood to reside in regions with pharmacy deserts.”
The researchers noted that their findings underscore how disparities compound to create barriers to access basic healthcare, noting the association between SVI and the number of chronic conditions.
“For example, diabetes and hypertension tend to be more prevalent among black patients living in rural areas,” the authors wrote. “Poor access to pharmacies is often associated with lower medication adherence. Patients in socially vulnerable communities may lack the means to travel to other pharmacies or may have limited access to broadband internet to find telepharmacy options. Furthermore, pharmacies often offer diagnostic, preventive, and emergency services.”
Complicating the situation is that high pharmacy desert density counties tend to also have a lower PCP density. “Patients residing in these regions face increased barriers to accessing primary health care needs,” the authors concluded.
The authors suggested that in future studies, weighted regression and inverse probability weighting could provide more insights into disparities in healthcare access.
That high SVI and low PCP density that were associated suggested that “people already at highest risk of being neglected by the health care system are most likely to be affected by pharmacy closures. More efforts are needed to maintain access to pharmacies in underserved communities.”
Filed under: General Problems
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