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Spatial analysis of community service availability in rural Kentucky, United States

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Abstract

This study examined community service provider (CSP) availability relative to neighborhood socioeconomic status and its association with health-related social needs in Eastern Kentucky, United States. We used GIS methods to generate 10-mile network service areas around addresses of 736 CSPs and 10,161 Medicaid and Medicare beneficiaries screened August 2018–April 2020 in 27-county study region. We observed wide variation in CSP availability and an inverse relationship between CSP availability and rates of unemployment, poverty, and federal Supplemental Nutrition Assistance Program. The CSPs appear to have higher availability in more affluent census block groups. We found a statistically significant negative relationship between CSP availability within 10 miles of a beneficiary’s resident and the presence of food, housing, transportation needs. Our findings suggest that healthcare providers, government entities, and non-profit organizations should consider geographic accessibility to those most in need when making referral and funding decisions, particularly in rural communities.

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Data availability

The data that support the findings of this study are not publicly available due to confidential Medicare and Medicaid beneficiary data that were obtained through a CMS-awarded project. Information on how to obtain it and reproduce the analysis is available from the corresponding author on request.

Code availability

All GIS and analytic software applications used in this study are publicly available. The analytic program/code is available from the corresponding author on request.

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Acknowledgements

We gratefully acknowledge Community Action Kentucky, God’s Pantry, and the Kentucky Housing Corporation for assisting us with identifying community service providers in our study region. The Appalachian Regional Healthcare, Inc. and Kentucky Primary Care Association member clinics played a key role in deploying Accountable Health Communities Model surveys to beneficiaries. The Kentucky Consortium for Accountable Health Communities Community advisory board aided with interpretation of regional patterns and provided feedback.

Funding

This study was supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $4.48 million with 100% funding by CMS/HHS (Grant Number: 1P1CMS331581; PIs: Williams/Li).

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Authors and Affiliations

  1. Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, KY, USA

    Aiko Weverka, Nikita L. Vundi, Jessica M. Clouser & Akosua K. Adu

  2. Department of Medicine, Washington University School of Medicine, 600 S Taylor Ave, St. Louis, MO, 63110, USA

    Mark V. Williams & Jing Li

Authors
  1. Aiko Weverka
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  2. Nikita L. Vundi
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  3. Jessica M. Clouser
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  4. Akosua K. Adu
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  5. Mark V. Williams
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  6. Jing Li
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Contributions

All authors approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AW contributed to contributed to the design of the work, data acquisition, analysis, interpretation of data, and drafted the work; NV contributed to data acquisition, interpretation of data, and revised it critically; JMC contributed to the design of the work, interpretation of data, and revised it critically; AKA contributed to data acquisition, interpretation of data, and revised it critically; MVW contributed to the conception of the work, interpretation of data, and revised it critically; JL contributed to the conception and design of the work, analysis, interpretation of data, and drafted and revised it critically.

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Correspondence to Jing Li.

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The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by, CMS/HHS, or the U.S. Government. The authors have no financial interests to disclose.

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Weverka, A., Vundi, N.L., Clouser, J.M. et al. Spatial analysis of community service availability in rural Kentucky, United States. J Public Health Pol 44, 6–22 (2023). https://doi.org/10.1057/s41271-022-00388-0

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