My name is Sidisha Pereira, and I will be presenting our work studying the relationship between socioeconomics, race, and neurosurgical workforce distribution in the United States. Access to neurosurgical care varies greatly across the U.S., while many factors influence access to care. An adequate and equitably distributed physician workforce is a necessary first step towards ensuring appropriate neurosurgical care nationwide. Our work examining the nation's neurosurgeon workforce have offered mixed conclusions, with some studies indicating a shortage of neurosurgeons and others suggesting a maldistribution problem. Regardless, multiple investigations agree that fewer neurosurgeons and greater distances from care are associated with worse outcomes. Furthermore, trends between workforce and outcomes represent a clearly measurable source of healthcare disparity. In this study, we examined how the neurosurgeon workforce distribution correlates with social determinants of health nationwide. To investigate this relationship, we aggregated data from publicly available resources. Socioeconomic data was sourced from the Brookings Institute, race and ethnicity data was sourced from CDC Wonder, and neurosurgeon density was sourced from the Health Resource and Service Administration's area health resource files. Socioeconomic factors included were income, poverty rate, vacancy rate, and prime age employment. To capture race and ethnicity, we included the proportion of the population that self-identified as Black, Asian, American Indian, and Hispanic. All variables were aggregated at the county level. Notably, over 2,500 counties have no registered practicing neurosurgeons, which together encompass a population of 77 million Americans. To circumvent this issue, we constructed 628 catchment areas, which integrated every county lacking care into the nearest available county. Characteristics for catchment areas were calculated as the population weighted average across all contained counties. Together, the catchment areas represent a mutually exclusive and collectively exhaustive breakdown of the entire U.S. population and all licensed neurosurgeons. From there, we performed linear regression analysis modeling two outcomes of interest. Neurosurgeon density measured as number of neurosurgeons per 100,000 in the population and estimated distance to care measured in miles. Mapping our first outcome of interest, we found that the catchment areas with the highest neurosurgeon densities are relatively scattered. However, as a general rule, neurosurgeons tend to cluster around large academic centers and in urban areas. Looking at our second outcome, we noticed clear regional trends in average distance to care. In particular, larger catchment areas in the southwest and mountain west were associated with greater distances to care than the geographically smaller catchment areas of the northeast and south. Linear regression analysis modeling neurosurgeon density revealed that catchment areas with higher poverty rates and higher PAE rates, as well as areas with higher proportions of Black residents, were significantly associated with a greater number of neurosurgeons per capita. Meanwhile, catchment areas with higher proportions of Hispanic residents displayed lower neurosurgeon density. Additionally, residents of catchment areas with higher housing vacancy rates, higher proportions of American Indian residents, and higher proportions of Hispanic residents travel farther on average to receive neurosurgical care, while people living in areas with lower income or higher proportions of Black residents travel a shorter distance. Putting it all together, we find that multiple factors correlate with neurosurgeon density. Most notably, Hispanic and American Indian populations may suffer from reduced access to care based on proximity to a number of neurosurgeons in their region. However, these results are difficult to contextualize. Currently, the literature contains no agreed upon ratio of neurosurgeons per capita for adequate coverage. Evidence regarding acceptable distance to care is similarly scarce. Overall, our findings call for further investigation to comprehensively characterize the inequities in access to neurosurgical care that stem from socioeconomic and racial disparities nationwide. To end, we'll touch on some limitations of this study. First, distance to care was estimated without accounting for intra-county population density or exact treatment center location. Actual distance to care for individual patients may vary widely within geographically large catchment areas. Furthermore, referral patterns and insurance networks may require patients to travel farther to obtain services, including crossing catchment areas. Finally, further subgroup analysis would be required to better understand access to critical subspecialty services such as trauma, stroke, and neuro-oncology that cannot be provided by community neurosurgeons.

socioeconomics

race

neurosurgical workforce

access to care

health disparities