Disparities in Access to Spasticity Chemodenervation Specialists in the US: A Retrospective Cross-Sectional Study

Abstract

Abstract Objective Explore variations in access to spasticity chemodenervation specialists across several geographical, ethnic, racial, and population density factors. Design A retrospective cross-sectional study on Medicare Provider Utilization and Payment Data. Providers with substantial adult spasticity chemodenervation practices (SASCPs) were included. Ratios were assessed across geographical regions as well as hospital referral regions (HRRs). A multivariate linear regression model for the top 100 HRRs by beneficiary population was created, using backward stepwise selection to eliminate variables with p-values >0.10 from final model. Results A total of 566 providers with SASCPs were included. Unadjusted results showed lower access in non-urban versus urban areas in the form of higher patient:provider ratios (83,106 vs 51,897). Access was also lower in areas with ≥25% Hispanic populations (141,800 vs 58,600). Multivariate linear regression results showed similar findings with urban HRRs having significantly lower ratios (-45,764 [p = 0.004] versus non-urban) and areas with ≥25% Hispanic populations having significantly higher ratios (+96,249 [p = 0.003] versus <25% Hispanic areas). Conclusions Patients in non-urban and highly Hispanic communities face inequities in access to chemodenervation specialists. The Medicare data set analyzed only includes 12% of the US patient population, however this elderly national cross-sectional cohort represents a saturated share of patients needing access to spasticity chemodenervation therapy. Future studies should venture to confirm whether findings are limited to this specialization, and strategies to improve access for these underserved communities should be explored.