Original Article
Geographic Access to Primary Healthcare Services among Latinos/as/x in Western Alabama
Abstract
Objectives: Alabama’s Latino/a/x population grew 278% from 2000 to 2018. Tuscaloosa County, located in the largely rural region of western Alabama, also experienced a significant influx of Latino/as/x during this time frame. Geographic healthcare access (GHA) to primary care and hospitals is crucial for immigrant Latino/as/x to care for their health, but few studies have characterized it. The goals of this article were to describe the availability (defined as number of provider locations) and accessibility (defined as travel impedance between potential patients and provider locations) of primary healthcare services and to discuss potential strategies to address these healthcare access challenges.Methods: We drew data from the US Census Bureau, American Community Survey 5-year estimates, Blue Cross Blue Shield national doctor and hospital finder database, the Alabama Department of Public Health, and Tuscaloosa Transit Authority. We used geographic data, geographic information systems, and spatial analyses to characterize the availability and accessibility of primary care services and hospitals for Latinos/as/x in Tuscaloosa County using ESRI, ArcGIS 10.6.1. We showed the distribution of Latinos/as/x by census tract with choropleth mapping and mapped primary healthcare providers alongside public transit routes and hospital driving times to support our findings.
Results: This work demonstrated that Latinos/as/x in Tuscaloosa County were concentrated in more rural areas surrounding the county’s city center, presenting significant barriers to GHA. These areas had fewer primary care providers and limited public transit. Many Latinos/as/x in this county had to travel ≥45 minutes to a hospital.
Conclusions: Outreach and technology-based approaches, including home visit programs, mobile health units, and telemedicine, may be particularly important in bridging the GHA gaps for this and other largely rural populations the southeastern United States. Some of this potential was unlocked during the coronavirus disease 2019 crisis. These gains should be leveraged toward sustainable healthcare access initiatives for rural Latino/a/x populations.
This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. US Census Bureau. Quick facts. United States. https://www.census.gov/quickfacts/fact/table/US/PST045221#qf-headnote-b. Published 2018. Accessed January 31, 2022.
2. Velasco-Mondragon E, Jimenez A, Palladino-Davis AG, et al. Hispanic health in the USA: a scoping review of the literature. Public Health Rev 2016;37:31.
3. Centers for Disease Control and Prevention. National Health Interview Survey. https://www.cdc.gov/nchs/nhis/index.htm. Accessed September 20, 2022.
4. Chavez-Dueñas NY, Adames HY, Perez-Chavez JG, et al. Healing ethno-racial trauma in Latinx immigrant communities: cultivating hope, resistance, and action. Am Psychol 2019;74:49.
5. Brown A, Lopez MH. Mapping the Latino Population, by State, County and City. Washington, DC: Pew Research Center; 2013.
6. US Census Bureau. Quick facts: Alabama. https://www.census.gov/quickfacts/fact/table/AL/PST045221#viewtop. Accessed July 2, 2021.
7. US Census Bureau. 2014-2018 American Community Survey 5-year estimates – ACS demographic and housing estimates. Published 2019. Accessed November 10, 2021.
8. Ferreti G, Morales-Aleman MM. No te tratan bien porque eres Mexicana: intersectional systemic violence and precarity in Latina adolescent life in the U.S. South. Peace Confl 2020;26:126–135.
9. Morales-Alemán MM, Ferreti G, Scarinci IC. “I don’t like being stereotyped, I decided I was never going back to the doctor”: sexual healthcare access among young Latina women in Alabama. J Immigr Minor Health 2020; 22:645–652.
10. White K, Scarinci IC. Comparison of self-rated health among Latina immigrants in a southern U.S. city and a national sample. Am J Med Sci 2015;350:290–295.
11. Guagliardo MF. Spatial accessibility of primary care: concepts, methods and challenges. Int J Health Geogr 2004;3:3.
12. Hu Q, Li X, Morales-Alemán MM. Pathway analysis to characterize the relationships between healthcare access and healthcare visits in the United States using the health information national trends survey. Int J Community Med Public Health 2022;9:1951–1960.
13. Hu Q, Li X, Bell G, et al. The impacts of internet and transportation access on patients’ health conditions: a cross-sectional study. Int J Community Med Public Health 2022;9:565–574.
14. Hiscock R, Pearce J, Blakely T, et al. Is neighborhood access to health care provision associated with individual-level utilization and satisfaction? Health Serv Res 2008;43:2183–2200.
15. Maldonado LY, Fryer KE, Tucker CM, et al. The association between travel time and prenatal care attendance. Am J Perinatol 2020;37:1146–1154.
16. Li X, Hu Q, Liu J, et al. Pathway analysis of relationships among community development, active travel behavior, body mass index, and self-rated health. Int J Sustain Transp 2021;16:340–356.
17. Monnat SM. The new destination disadvantage: disparities in Hispanic health insurance coverage rates in metropolitan and nonmetropolitan new and established destinations. Rural Sociol 2017;82:3–43.
18. Edward J, Biddle DJ. Using geographic information systems (GIS) to examine barriers to healthcare access for Hispanic and Latino immigrants in the US south. J Racial Ethn Health Disparities 2017;4:297–307.
19. Delmelle EM, Cassell CH, Dony C, et al. Modeling travel impedance to medical care for children with birth defects using Geographic Information Systems. Birth Defects Res A Clin Mol Teratol 2013;97:673–684.
20. Lovett A, Haynes R, Sünnenberg G, et al. Car travel time and accessibility by bus to general practitioner services: a study using patient registers and GIS. Soc Sci Med 2002;55:97–111.
21. Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care 1981;19:127–140.
22. Economic Research Service, US Department of Agriculture. What is rural?https://www.ers.usda.gov/topics/rural-economy-population/rural-classifications/what-is-rural.aspx. Updated October 23, 2019. Accessed September 21, 2022.
23. University of Wisconsin Population Health Institute. Alabama: primary care physicians. https://www.countyhealthrankings.org/explore-health-rankings/alabama?year=2019&measure=Primary+Care+Physicians. Accessed July 12, 2021.
24. Phillips N. Primary Care Professional Shortage Areas, January 2019. Primary Care Rural Health. 2019. Available at: https://www.alabamapublichealth.gov/healthrankings/assets/primary_care_health_shortages.pdf. Accessed October 15, 2022.
25. Blue Cross Blue Shield. https://www.bcbs.com/find-a-doctor. Accessed September 21, 2022.
26. Tuscaloosa Transit Authority. Route information. Fixed route services information. http://www.tuscaloosatransit.com/routeInfo.php. Accessed September 21, 2022.
27. KFF. Market share and enrollment of largest three insurers - large group market. https://www.kff.org/other/state-indicator/market-share-and-enrollment-of-largest-three-insurers-large-group-market/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed August 22, 2021.
28. Hubbard R. Blue Cross Blue Shield's $2.8 billion in assets draws criticism. The Birmingham News. Available at: https://www.al.com/businessnews/2012/08/blue-cross_blue_shields_28_bil.html. Accessed October 15, 2022.
29. US Census Bureau. Census tracts and block numbering areas, 4-19-2000 to 12-5-2007. Available at: https://www.census.gov/history/www/programs/geography/tracts_and_block_numbering_areas.html. Accessed December 10, 2021.
30. Jenks GF. Generalization in statistical mapping. Ann Assoc Am Geogr 1963; 53:15–26.
31. Baz I, Geymen A, Er SN. Corrigendum to "Development and application of GIS-based analysis/synthesis modeling techniques for urban planning of Istanbul Metropolitan Area." Adv Eng Softw 2010;41:406.
32. ArcGIS Desktop 10.6.1. https://desktop.arcgis.com/en/arcmap/10.6/get-started/setup/arcgis-desktop-quick-start-guide.htm. Accessed September 21, 2022.
33. Schuurman N, Fiedler RS, Grzybowski SC, et al. Defining rational hospital catchments for non-urban areas based on travel-time. Int J Health Geogr 2006;5:43.
34. Alabama Public Health, Bureau of Health Provider Standards. Facilities descriptions. https://www.alabamapublichealth.gov/providerstandards/ descriptions.html#:~:text=A%20health%20institution%20planned%2C% 20organized,than%20twenty%2Dfour%20consecutive%20 hours. Accessed June 14, 2021.
35. Hare TS, Barcus HR. Geographical accessibility and Kentucky's heart-related hospital services. Appl Geogr 2007;27:181–205.
36. McGregor J, Hanlon N, Emmons S, et al. If all ambulances could fly: putting provincial standards of emergency care access to the test in northern British Columbia. Can J Rural Med 2005;10:163.
37. Li X, Hu Q, Gregg A. An integrated spatio-temporal analysis of emergency medical service response characteristics for stroke events across Alabama. J Transp Health 2021;20:101018.
38. Nassir N, Hickman M, Malekzadeh A, et al. A utility-based travel impedance measure for public transit network accessibility. Transp Res Part A Policy Pract 2016;88:26–39.
39. Pew Research Center. Demographic and economic profiles of Hispanics by state and county, 2014. Alabama. https://www.pewresearch.org/hispanic/states/state/al. Accessed September 21, 2022.
40. Topchik M, Gross K, Pinette M, et al. The rural health safety net under pressure: rural hospital vulnerability. https://www.chartis.com/insights/rural-health-safety-net-under-pressure-rural-hospital-vulnerability. Published 2022. Accessed September 21, 2022.
41. Passel JS, Cohn D, Lopez MH. Census 2010: 50 million Latinos. Hispanics account for more than half of nation’s growth in past decade. http://pewhispanic.org/files/reports/140pdf. Published March 24, 2011. Accessed September 21, 2022.
42. HB 658, Act No. 2012-491, §5 (2012 Ala) .
43. Briant KJ, Sanchez JI, Ibarra G, et al. Using a culturally tailored intervention to increase colorectal cancer knowledge and screening among Hispanics in a rural community. Cancer Epidemiol Biomarkers Prev 2018; 27:1283–1288.
44. Rangel Gomez MG, López Jaramillo AM, Svarch A, et al. Together for Health: an initiative to access health services for the Hispanic/Mexican population living in the United States. Front Public Health 2019;7:273.
45. Stone GA, Fernandez M, DeSantiago A. Rural Latino health and the built environment: a systematic review. Ethn Health 2022;27:1–26.
46. Martinez M, Perle JG. Reaching the Latino population: a brief conceptual discussion on the use of telehealth to address healthcare disparities for the large and growing population. J Technol Behav Sci 2019;4:267–273.
47. Mehrotra A, Bhatia RS, Snoswell CL. Paying for telemedicine after the pandemic. JAMA 2021;325:431–432.
48. Tulimiero M, Garcia M, Rodriguez M, et al. Overcoming barriers to health care access in rural Latino communities: an innovative model in the eastern Coachella Valley. J Rural Health 2021;37:635–644.
49. Philbin MM, Flake M, Hatzenbuehler ML, et al. State-level immigration and immigrant-focused policies as drivers of Latino health disparities in the United States. Soc Sci Med 2018;199:29–38.
50. Kissam E. Differential undercount of Mexican immigrant families in the US Census. Stat J IAOS 2017;33:797–816.
