Healthcare Deserts in Virginia: Rural-Urban and Socioeconomic Disparities in Access to Care

Abstract

Many rural communities in the United States live in healthcare deserts, areas without access to care within a reasonable time, leading to higher rates of mortality and chronic disease compared to urban populations. While several studies examine healthcare access at an aggregate level, few focus on the unequal distribution of healthcare deserts across rural and urban areas and the related socio-economic disparities, especially in Virginia (VA). To address this gap, this study measures healthcare deserts in VA and explores their rural-urban and socio-economic drivers. We perform our analysis at both county and census tract levels, using different travel time thresholds and multiple provider types to understand how health desert measures vary across spatio-temporal scales and healthcare needs. Using hospital location data from the Dewey database and their NAICS codes, we classify hospitals into five categories: (1) physicians, (2) outpatient care and community health centers, (3) general medical and surgical hospitals, (4) specialty hospitals, and (5) mental health facilities. We also include socio-economic variables such as poverty rates, racial composition, vehicle ownership, and health insurance coverage, along with rural-urban classification data from the American Community Survey and the US Department of Agriculture. For each provider type, we calculate an access index representing the number of facilities reachable within 15- and 30-minute driving thresholds. Census tracts and counties with an access index of zero are classified as healthcare deserts. Next, we use binary logistic regression to examine how socio-economic and rural-urban factors influence the likelihood of a county or census tract being a healthcare desert. Our results reveal that between 12% and 50% of counties and 30% to 42% of tracts are considered health deserts across both time thresholds and all five provider types. Rural areas with additional socio-economic disadvantages are significantly more likely to be classified as health deserts than urban areas. These findings can help practitioners and policymakers identify the most healthcare-disadvantaged communities and develop targeted investments and policies to ensure equitable healthcare access throughout Virginia.