New research highlights significant geographic disparities in the availability of gastroenterologist care across the United States. The study reveals that rural areas and regions with low household incomes face limited access compared to urban locations.
The findings indicate a stark imbalance in the number of gastroenterologists relative to the patient population suffering from inflammatory bowel disease (IBD), particularly in the Midwest and Southwest regions. Dr. Jonathon Casey Chapman, a gastroenterologist at Gastroenterology Associates in Baton Rouge, Louisiana, and his colleagues claim, “To the best of our knowledge, this is the first nationwide study to comprehensively assess the density of GI specialists at a granular, local level across the US.”
The researchers conducted a descriptive retrospective analysis to evaluate the density of gastroenterologists using data from various sources, including the 2022 National Provider Identifier registry and the 2020 US Census. This analysis considered the first three digits of US postal codes (ZIP codes) as geographical markers. In total, the study included data from 520,020 patients diagnosed with IBD.
At the national level, the density of patients with IBD was recorded at 156.9 per 100,000 population. Variations were observed at the state level, where Maine (337.1) and Rhode Island (251.4) reported the highest densities, while New Mexico (58.2) and Hawaii (63.6) had the lowest.
A troubling aspect of the research is the disparity in the availability of gastroenterologists. The national average stands at 6.5 gastroenterologists per 100,000 population. Some states, such as Kansas (2.0) and Wyoming (3.1), have significantly lower densities, while New Jersey (11.2) and Rhode Island (10.8) have higher concentrations of specialists.
The analysis also revealed further disparities in the ratio of gastroenterologists to patients with IBD. Nationally, the density of gastroenterologists per 100 patients with IBD is only 4.2. In Kansas, this figure drops to 1.4, while Maine shows a density of 1.9. Surprisingly, despite Michigan ranking among the top states with the highest number of IBD patients (23,969), its gastroenterologist density per 100 patients with IBD is a mere 2.2.
The study’s findings are concerning, especially given that one-fifth of ZIP codes had a gastroenterologist density of less than 1 per 100 patients. Over one-third of ZIP codes reported a density between 1 and 5. Alarmingly, 130 ZIP codes had no gastroenterologists at all, with 62% of these located in rural areas and 25% in regions with household incomes below 150% of the poverty line.
Investigators noted that areas with a higher density of gastroenterologists tend to have lower poverty rates and are predominantly urban. “This study shows that despite the burden of IBD in the US, the geographic distribution of gastroenterologists varies widely,” the authors concluded. “Rural areas and areas with low household incomes have fewer gastroenterologists than urban areas, indicating disparities in the availability of GI specialists.”
As treatment options expand, including the recent FDA approval of a single-injection, once-monthly maintenance regimen of Omvoh (mirikizumab-mrkz) for adults with ulcerative colitis, barriers still exist. Patients face hurdles such as insurance restrictions and access to specialists, which complicate their care.
The insights gained from this research could inform healthcare policies aimed at better resource allocation for underserved populations with IBD across the United States. Addressing these disparities is crucial for improving access to essential healthcare services for all patients.
