Abstract
Spatial access to care describes the ability of populations to travel to healthcare providers. Existing spatial access to care studies frequently utilize metrics constructed using car-specific travel to providers, potentially underestimating access in populations using other travel modalities (i.e., walking/transit). We present a novel multi-travel modality spatial access to care composite measure, a corresponding temporally representative open-source data resource, and a stratified analysis of neighborhood rural/urban and socioeconomic disparities. We utilized quarterly 2016-2020 Centers for Medicare and Medicaid Services Doctors and Clinicians National Downloadable Files to compute temporally representative multi-modal spatial accessibility to 56 healthcare provider classifications in U.S. census tracts and block groups. We performed tract-level analyses stratified by 2010 Rural-Urban Commuting Area Codes and 2016 Area Deprivation Index for a subset of provider types. We found that 1) non-metropolitan areas have poorer multi-modal spatial access to primary (P < 0.001), specialty (P < 0.001), pulmonology (P < 0.001), nephrology (P < 0.001), and cancer care (P < 0.001) than metropolitan areas both cross-sectionally and over time and 2) multi-modal primary care access was substantially poorer than multi-modal specialty care access in 2016 and this trend did not improve over time. We also produced a data resource for many provider types and an interactive spatial access map for a subset of provider classifications. After stratifying, we found significant disparities in spatial access to primary care, specialty care, pulmonology, nephrology, and cancer care in non-metropolitan areas. Our multi-modal spatial access measure and corresponding data resource may be useful for population health and clinical studies, public health entities, community stakeholders, health systems, and policymakers.