Mapping surgical deserts of cardiovascular training in Latin America: A geospatial and structural analysis

Latin America faces significant disparities in cardiovascular surgery training access. We used a driven geospatial analysis to map surgical deserts-underserved regions to surgical education-and quantified disparities through population-adjusted density metrics and structural variables.

Geospatial analysis mapped all cardiovascular surgery training programs in Latin America. A Composite Access Index (density, travel time, economics, structure) was developed. Hierarchical clustering and regression were used to identify surgical deserts and structural impacts, revealing 3 types: geographic, structural, and economic.

A total of 243 cardiovascular surgery programs across 19 Latin American countries provided 454 annual positions. Brazil leads with 170 programs and 280 positions, whereas Guatemala, Honduras, and Nicaragua each have 1 program offering 2 positions. Program density is greatest in Cuba (3.39 positions/million), followed by Uruguay (0.88), Peru (0.73), and Panama (0.67), and lowest in Guatemala (0.11), Argentina (0.13), and Venezuela (0.14). Integrated residency models exist in Cuba, Panama, Peru, and Ecuador; only Brazil, Chile, Mexico, and Venezuela require board examinations. Health spending per capita ranges from $934 in Chile to $35 in Haiti. The Composite Access Index highlights high-access countries (Cuba 1.00, Uruguay 0.95, Chile 0.85), moderate-access (Brazil 0.69, Peru 0.75, Colombia 0.64), and limited-access "surgical deserts" (Bolivia 0.31, Guatemala 0.27). Regression analyses showed no significant effect of structure requirements on access (P > .77). Funding, decentralization, and geography are primary determinants of equitable training.

This comprehensive mapped study exposes that cardiovascular surgery training in Latin America is highly unequal; surgical deserts persist as a result of limited funding, geographic isolation, and program decentralization, whereas structural requirements minimally influence access.