Travel Costs and Health Disparities: The Impact of Rurality and Social Vulnerability on Hand Therapy Access in...

Postoperative hand therapy is important for recovery and enhanced functional outcomes following hand surgery. Access to this essential care is limited in Alabama, however, particularly for vulnerable populations in rural areas where public transportation is scarce. These challenges are further amplified for patients who are unable to drive due to their injuries. This study aimed to quantify disparities and barriers to certified hand therapy access in Alabama.

Certified hand therapists in Alabama were identified through the Hand Therapy Certification Commission directory. Practice addresses were geocoded and paired with county center coordinates to calculate travel distances from each county center to the nearest certified hand therapist. These distances were then converted into one-way travel costs using Internal Revenue Service standard mileage rates. Counties were categorized by rurality using Rural-Urban Continuum Codes (RUCC) and assessed for social vulnerability using the Social Vulnerability Index (SVI), which considers socioeconomic, housing, and transportation factors. Statistical analyses, including t tests, χ² tests, and multivariate regression, were used to evaluate patterns and predictors of travel costs.

Alabama counties had a mean SVI of 0.67 ± 0.195-significantly higher than the national mean of 0.50 (P<0.0001). More than 80% of Alabama counties rank in the most vulnerable 50% of US counties, with Shelby County being the only county in the least vulnerable quartile (SVI 0.116). In addition, 36 counties (53.7%) are classified as rural (RUCC 4-9). Both SVI and RUCC independently correlated with increased travel costs. Multivariate regression modeling revealed that each unit increase in RUCC was associated with a $3.43 increase in travel costs (P<0.0001), and each 10% increase in SVI corresponded to a $1.64 increase in travel costs (P=0.006). These factors explained 56.4% of the variability in travel costs. Heatmaps visually highlighted higher travel costs in rural, socially vulnerable areas.

Rural and socially vulnerable populations in Alabama face significant travel barriers to accessing certified hand therapy. The combined impact of geographic isolation and social vulnerability underscores the need for targeted interventions to ensure equitable access to postoperative care.