Residential segregation and disparities in the availability of community pharmacies

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.