Jan M Eberth1, Whitney E Zahnd2, Michele J Josey3, Mario Schootman4, Peiyin Hung5, Janice C Probst6. 1. Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA; Department of Epidemiology and Biostatistics, University of South Carolina, SC, USA; Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA. Electronic address: jmeberth@mailbox.sc.edu. 2. Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA. 3. Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA; Department of Epidemiology and Biostatistics, University of South Carolina, SC, USA; Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA. 4. Department of Clinical Analytics, SSM Health, Saint Louis, MO, USA. 5. Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA. 6. Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA; Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA.
Abstract
BACKGROUND: Colonoscopy use has increased since Medicare began covering screening for average-risk persons. Our objective was to describe changes in spatial access to colonoscopy in South Carolina (SC) between 2000 and 2014. METHODS: Using data from the SC Ambulatory Surgery Database, we created annual ZIP Code Tabulation Area (ZCTA) spatial accessibility scores. We assessed changes in accessibility, colonoscopy supply, and potential demand, overall and by metropolitan designation. Spatial clustering was also explored. RESULTS: Spatial accessibility decreased across both small rural and metropolitan ZCTAs but was significantly higher in metropolitan areas during the first part of the study period . The proportion of persons with no access to colonoscopy within 30 min increased over time but was consistently higher in small rural areas. Clusters of low accessibility grew over time. CONCLUSIONS: The supply of colonoscopy facilities decreased relative to the potential demand, and clusters of low access increased, indicating a contraction of services.
BACKGROUND: Colonoscopy use has increased since Medicare began covering screening for average-risk persons. Our objective was to describe changes in spatial access to colonoscopy in South Carolina (SC) between 2000 and 2014. METHODS: Using data from the SC Ambulatory Surgery Database, we created annual ZIP Code Tabulation Area (ZCTA) spatial accessibility scores. We assessed changes in accessibility, colonoscopy supply, and potential demand, overall and by metropolitan designation. Spatial clustering was also explored. RESULTS: Spatial accessibility decreased across both small rural and metropolitan ZCTAs but was significantly higher in metropolitan areas during the first part of the study period . The proportion of persons with no access to colonoscopy within 30 min increased over time but was consistently higher in small rural areas. Clusters of low accessibility grew over time. CONCLUSIONS: The supply of colonoscopy facilities decreased relative to the potential demand, and clusters of low access increased, indicating a contraction of services.
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