Online Program

Residential segregation and disparities in the availability of community pharmacies

Tuesday, November 5, 2013

Dima Qato, PharmD, MPH, PhD, University of Illinois, Chicago, IL
Jocelyn R. Wilder, MPH, University of Illinois, chicago, IL
Background. Residential segregation in the U.S. by race/ethnicity has been increasingly associated with disparities in access to healthcare of minority populations. The relationship between residential segregation and disparities in the accessibility of pharmacies, however, has not been previously examined. Racial/ethnic disparities in the use of prescription medications may be related, in part, to disparities in access to pharmacies. Objectives. 1. To determine the availability of pharmacies (number and growth) in Chicago's 77 community areas between 1990 and 2010; and 2. To examine the relationship between the availability of pharmacies and community racial/ethnic composition. Methods: Data on community pharmacies were derived from the Illinois Department of Financial and Professional Regulation (IDFPR) from 1980-2010. Census 2010 data was used to define population characteristics for Chicago's 77 community areas. A total of six community segments were defined as either segregated or integrated based on population racial/ethnic composition. Segregated communities were those in which >50% of the population was Black, Hispanic or White; Integrated communities were defined as those with >35% White and >35% Hispanics (Ethnically Integrated) or >35% Black (Racially Integrated). Pharmacy growth was defined as the percent change in the number of available pharmacies. ANOVA was used to test for statistically significant differences in pharmacy availability between community segments. Results. In 2010, there were 654 community pharmacies distributed across Chicago's 77 communities with an average of 8.7(95% CI 6.88,10.57) pharmacies in each community area. There was a 15.5% decline (CI -21.7, -9.21) in the number pharmacies in Chicago in 2010 compared to 2000. There were also disparities in the availability of pharmacies by community racial/ethnic composition. In 2010, in comparison to segregated White communities, segregated Black communities had significantly fewer pharmacies (mean 5.57 vs. 13.71; p=0.001) and a significantly greater decline in pharmacies compared to 2000 (-33.9% vs. -7.6%; p=0.0007). While segregated Hispanic communities had a mean of 7.5 (CI 4.8, 10.2) pharmacies, their pharmacy decline of -7.2% was similar to segregated White communities. In addition, integrated communities had more pharmacies and a lower decline in pharmacy growth in comparison to their segregated counterparts. Conclusions. These data provide recent estimates of pharmacy availability in Chicago and across its racially/ethnically-segregated communities. Residential segregation, particularly in Black communities, is associated with disparities in the availability of pharmacies that seems to worsen with time. These findings suggest that persistent racial/ethnic disparities in the use of prescription medications may be related to the accessibility of pharmacies.

Learning Areas:

Chronic disease management and prevention
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Social and behavioral sciences

Learning Objectives:
Demonstrate the relationship between residential segregation and disparities in pharmacy accessibility Discuss the role of limited availability of pharmacies in black and hispanic segregated communities on racial/ethnic disparities in the use of prescription medications.

Keyword(s): Pharmacies, Access to Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a community pharmacist and health services researcher with prior experience conducting research related to disparities in access to medicines in vulnerable populations in the U.S. and globally. I have previously conducted field work and quantitative/qualitative analyses pertaining to disparities in access to health care, including access to medication. This abstracts focus on pharmacy accessibility is a new contribution to the field of both access to health care, and access to medicines.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.