Rural-Urban Disparities in Access to Otolaryngology Care in Louisiana

Abstract

Objectives:

To highlight and quantify rural-urban disparities in access to otolaryngology care in Louisiana.

Study design:

Observational population study.

Methods:

Louisiana parishes (county-equivalents) were categorized by rurality using the National Center for Health Statistics 2023 urban-rural classification. Class levels range from I to VI, with lower class levels corresponding to more urban parishes and higher levels corresponding to more rural parishes. Otolaryngologist data was obtained upon request and fee to the Louisiana State Board of Medical Examiners and freely accessible residency program websites. Population data was obtained from the 2022 U.S. Census postcensal estimates. Travel burden was estimated by mean distance between parish centroid to the closest otolaryngology practice. Provider density was estimated by number of otolaryngologists per 100 000 population. Population-weighted linear regression models were fit using R version 4.5.1 to compare differences in mean distance and mean provider density per parish across NCHS class levels.

Results:

There are 261 otolaryngologists in Louisiana and 91 practice locations. 61% of parishes lack an ENT provider. Overall statistical significance was found (F(3, 60) = 9.10, P < .0001) in comparison of miles to an otolaryngology provider across classes: Class III, 6.55; Class IV, 7.41 (P = .78); Class V, 17.99 (P < .05), Class VI, 29.92 (P < .0001). Overall statistical significance was found (F(3,60) = 4.93, P < .005) in comparison of number of otolaryngologists per 100 000 population across classes: Class III, 7.54; Class IV, 3.27 (P < .05); Class V, 1.67 (P < .05); Class VI, 0.98 (P < .05).

Conclusion:

There is a clear discrepancy in number of ENT providers located in urban and rural parishes, indicating a need to advocate for more evenly distributed resources and providers throughout the state. Additional clinical outreach, like remote outreach clinics, could help expand and more effectively streamline access to specialized otolaryngology care for patients in rural areas.