Rethinking access to care: A spatial-economic analysis of the potential impact of pharmacy closures in the United States.

Data chronicling the geo-locations of all 61,589 pharmacies in the U.S. (from the Homeland Infrastructure Foundation-Level Data (HIFLD) Open Data interface, updated on April 2018) across 215,836 census block groups were combined with Medically Underserved Areas (MUAs) information, and the Centers for Disease Control and Prevention's Social Vulnerability Index (CDC-SVI). Geospatial techniques were applied to calculate the distance between the center of each census block and the nearest pharmacy. We then modeled the expected additional travel distance if the nearest pharmacy to the center of a census block closed and estimated additional travel costs, CO2 emissions, and lost labor productivity costs associated with the additional travel. Our findings revealed that MUA residents have almost two times greater travel distances to pharmacies than non-MUAs (4,269 m (2.65 mi) vs. 2,388 m (1.48 mi)), and this disparity is exaggerated with pharmacy closures (107% increase in travel distance in MUAs vs. 75% increase in travel distance in non-MUAs). Similarly, individuals living in MUAs experience significantly greater average annual economic costs than non-MUAs ($34,834 ± $668 vs. $22,720 ± $326). Our findings suggest the need for additional regulations to ensure populations are not disproportionately affected by these closures and that there is a significant throughput with community stakeholders before any pharmacy decides to close.