For Urban-Based African Americans, Proximity to a Dermatologist Varies by ZIP Code

Doug Brunk

June 24, 2020

Urban ZIP codes with higher percentages of African American people tend to have fewer dermatologists. In these areas, dermatologists are not able meet the populations' needs, based on the suggested ratio of patients per dermatologist.

The findings come from an analysis which used U.S. Census data to compare dermatologists' distribution in urban ZIP codes with high and low representation of African Americans.

"It has been demonstrated that there is a non-uniform geographic distribution of dermatologists, in which they tend to practice in urban settings," the study's first author, Nathan Vengalil, MD, said in an interview following the virtual annual meeting of the American Academy of Dermatology. "Furthermore, it is also an unfortunate reality that African Americans suffer from inferior access to care compared to whites across health care. The same is true within dermatology; for example, African Americans face higher morbidity and mortality from melanoma, compared to their white counterparts."

For the current study, Dr. Vengalil, a recent graduate of the University of Michigan, Ann Arbor, and associates in the university's department of dermatology drew from 2010 U.S. Census data to identify ZIP codes with populations of 25,000 people and greater, because these should have at least one dermatologist to care for a community of that size (JAMA Dermatology 2017;153[5]:472-3).

Next, they ordered these ZIP codes from low to high concentrations of African American people. Those that fell in the 15th percentile or fewer were categorized as "low" (a total of 370 ZIP codes), while those that fell in the 85th percentile or higher were categorized as "high" (a total of 443 ZIP codes). Following this, the Definitive Healthcare provider database was used to identify the number of dermatologists practicing within each ZIP code and to calculate the average number of people per dermatologist in the "low" and "high" categories.

The researchers found that ZIP codes with high percentage of African American people have an average of 1.02 dermatologists (1 per 39,367 people), which is below the recommended limit of 1 per 25,000 people. Meanwhile, ZIP codes with a low percentage of African American people averaged 2.84 dermatologists (1 per 14,000 people), which is above the adequate limit. "ZIP codes with a low percentage of African Americans had, on average, almost three times more dermatologists than ZIP codes with a high percentage of American Americans," Dr. Vengalil said. "This means that predominantly African American urban communities may face consequences of low provider availability including longer waits times, decreased diagnosis of skin cancer, and worse health care outcomes."

He acknowledged certain limitations of the study, including the fact that it focused only on the distribution of dermatologists to assess communities' access to dermatologic care. "It would be interesting to measure how much mid-level providers such as nurse practitioners and physician assistants are able to compensate for the low number of dermatologists in urban ZIP codes with high numbers of African Americans," Dr. Vengalil said.

The study's findings suggest that the distribution of dermatologists is not uniform even within the urban environment, especially when comparing areas with different representations of African American persons. "This reveals that lack of provider proximity may contribute to barriers that urban African Americans face in accessing dermatologic care," he concluded. "Looking toward the future, it will be important to incentivize the development of practice locations in urban African American communities to combat the health disparities of our most underserved patients."

The study's other authors were Mio Nakamura, MD, MS, and Yolanda Helfrich, MD. The researchers reported having no financial disclosures.

American Academy of Dermatology (AAD) 2020 Annual Meeting: Abstract 16772.

This article originally appeared on MDEdge.com.

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