GEOGRAPHIC DISPARITIES IN TREATMENT ACCESS FOR TEXAS MEDICAID PEDIATRIC PATIENTS WITH SICKLE CELL DISEASE
Author(s)
Taehyung Kim, Pharm.D, MS1, Hyeun Ah KANG, MEd, MS, RPh, PhD1, Hanqi Li, MS2, Yuhao Kang, PhD3;
1The University of Texas at Austin, Health Outcomes Division, College of Pharmacy, Austin, TX, USA, 2Louisiana State University, Department of Geography and Anthropology, Baton Rouge, LA, USA, 3The University of Texas at Austin, GISense Lab, Department of Geography and the Environment, College of Liberal Arts, Austin, TX, USA
1The University of Texas at Austin, Health Outcomes Division, College of Pharmacy, Austin, TX, USA, 2Louisiana State University, Department of Geography and Anthropology, Baton Rouge, LA, USA, 3The University of Texas at Austin, GISense Lab, Department of Geography and the Environment, College of Liberal Arts, Austin, TX, USA
OBJECTIVES: Patients with sickle cell disease (SCD) often experience limited access to specialized care, particularly in rural areas, contributing to poorer health outcomes. This study aims to assess geographic disparities in access to specialized treatment among Texas Medicaid pediatric patients with SCD.
METHODS: This retrospective study used Texas Medicaid claims data from 01/2016 to 06/2024. Patients were included if they had ≥1 inpatient or ≥2 outpatient visits with an SCD diagnosis on separate dates during the study period and were <18 years old as of 11/2023, when the pediatric hematologist provider list was last updated by Texas Health and Human Services. Geographic accessibility was measured using a gravity-based Two-Step Floating Catchment Area (2SFCA) method, which accounts for provider and patient distributions and distance decay. County and ZIP code centroids were used to represent locations, and travel distances were computed using the Google Maps application programming interface (API). Accessibility scores were categorized into five categories based on the Natural Breaks (Jenks) classification.
RESULTS: The study included 4,161 pediatric patients with SCD and 36 pediatric hematologists. Areas with the highest accessibility (1st and 2nd groups) were concentrated in major metropolitan statistical areas (MSAs) and often aligned with high patient populations, but this alignment occurred in just 7 of the top 10 patient-dense areas. Three South Texas regions showed high accessibility because one pediatric hematologist rotated across three clinics in these areas. Conversely, despite relatively large patient populations, most of East Texas had the lowest accessibility due to the absence of providers.
CONCLUSIONS: Substantial geographic disparities in specialized care exist among Texas Medicaid pediatric patients with SCD, with particularly low accessibility in East Texas and most non-metropolitan regions. Targeted interventions, such as encouraging provider rotation in underserved areas, are needed to reduce treatment access disparities for this vulnerable population.
METHODS: This retrospective study used Texas Medicaid claims data from 01/2016 to 06/2024. Patients were included if they had ≥1 inpatient or ≥2 outpatient visits with an SCD diagnosis on separate dates during the study period and were <18 years old as of 11/2023, when the pediatric hematologist provider list was last updated by Texas Health and Human Services. Geographic accessibility was measured using a gravity-based Two-Step Floating Catchment Area (2SFCA) method, which accounts for provider and patient distributions and distance decay. County and ZIP code centroids were used to represent locations, and travel distances were computed using the Google Maps application programming interface (API). Accessibility scores were categorized into five categories based on the Natural Breaks (Jenks) classification.
RESULTS: The study included 4,161 pediatric patients with SCD and 36 pediatric hematologists. Areas with the highest accessibility (1st and 2nd groups) were concentrated in major metropolitan statistical areas (MSAs) and often aligned with high patient populations, but this alignment occurred in just 7 of the top 10 patient-dense areas. Three South Texas regions showed high accessibility because one pediatric hematologist rotated across three clinics in these areas. Conversely, despite relatively large patient populations, most of East Texas had the lowest accessibility due to the absence of providers.
CONCLUSIONS: Substantial geographic disparities in specialized care exist among Texas Medicaid pediatric patients with SCD, with particularly low accessibility in East Texas and most non-metropolitan regions. Targeted interventions, such as encouraging provider rotation in underserved areas, are needed to reduce treatment access disparities for this vulnerable population.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR16
Topic
Health Policy & Regulatory
Disease
SDC: Pediatrics, SDC: Rare & Orphan Diseases, SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)