Geographical accessibility to smoking cessation treatment facilities across 335 medical areas in Japan: A nationwide...

Geographical research on tobacco control has focused predominantly on tobacco retail environments, whereas spatial accessibility studies using methods such as Enhanced Two-Step Floating Catchment Area (E2SFCA) have examined primary care but rarely smoking cessation services. This study aimed to evaluate the geographical accessibility of smoking cessation clinics and hospitals across Japan's secondary medical areas (SMAs) in a cross-sectional ecological spatial analysis using large-scale spatial data.

Accessibility scores (AS) were calculated at 422804 grids nationwide using E2SFCA. Demand was defined as the smoking rate-adjusted population, and supply comprised approximately 19000 facilities registered under Japan's insurance-covered smoking cessation program. A regional typology was developed using Ward's hierarchical cluster analysis. The distribution of standardized claim ratios (SCRs) from nationwide claims data (2018-2022) was examined descriptively across clusters.

Of the 335 SMAs, 319 were analyzed after excluding 16 areas with missing SCR data. The median AS varied substantially across areas (range: 286-5626). Three clusters emerged: Cluster 1, 'Low accessibility-High disparity' (24.1%); Cluster 2, 'Moderate accessibility-Low disparity' (62.4%); and Cluster 3, 'High accessibility-Low disparity' (13.5%). Clusters 2 and 3 showed similar Gini coefficients, differing primarily in AS levels. Cluster 3 showed descriptively higher SCR values (median: 117) compared with Clusters 1 and 2 (median: 93-95).

This study demonstrates substantial geographical disparities in the accessibility of smoking cessation services in Japan. Regions with higher accessibility tended to exhibit lower intra-regional disparities. For the implementation of the WHO FCTC Article 14, ensuring an equitable geographical distribution of services may be as important as expanding the overall number of facilities.