A Geospatial Analysis of the Rhinologist Workforce in the United States

Geospatial evaluation of access to otolaryngology care in the United States

Objectives

This county-level epidemiological study evaluated the travel distance to the nearest otolaryngologist for continental US communities and identified socioeconomic differences between low- and high-access regions.

Methods

Geospatial analysis of publicly available 2015-2022 NPI records was combined with US census data to identify geospatial gaps in otolaryngologist distribution. Moran's index geospatial clustering in distance to the nearest county with an otolaryngologist was used as the core metric for differential access determination. Univariate logistic analysis was conducted between low- and high-access counties for 20 socioeconomic and demographic variables.

Results

Nationally, the average person was 22 miles from an otolaryngologist. 444 counties were identified as geospatially "low access" with increased travel distance in the Midwest, Great Planes, and Nevada with a median of 47 miles. 1231 counties in the Eastern United States and Western Coast were identified as "high access" with a 3-mile median travel distance. Areas of low access to otolaryngological care had smaller median populations (12,963 vs. 558,306), had smaller percent Black and Asian populations (2% vs. 11%, 1% vs. 5%, respectively), had a greater percent American Indian population (2% vs. 1%), were less densely populated (8 vs. 907 people per square mile), had fewer percent college graduates (20% vs. 34%), and fewer otolaryngologists per county (median: 0.01-20).

Conclusion

These findings highlight disparity in otolaryngology care in the United States and the need for otolaryngology funding initiatives in the Midwest and Great Plains regions.

Level of Evidence

Level 3.