[The relationship between area deprivation and the accessibility of general practices in Germany: An ecological study...

Higher area deprivation leads to higher morbidity and demand for health services. A negative association between area deprivation and spatial accessibility of general practices could lead to gaps in health services supply. Previous studies found different associations of deprivation and accessibility, along with accessibility differences due to settlement structure.

We investigated the population-weighted straight-line distance to the next general practice for 11,085 municipalities in Germany (borders on Dec. 31, 2015) using multiple OLS regression models. Independent variables were the German Index of Multiple Deprivation (GIMD) 2015, centrality, and urbanity (Raumtyp 2010). We also modelled interaction effects of GIMD with centrality and urbanity.

We found statistically significant longer distances to the next practice (402-433 m, or 5-9 %) in municipalities with the highest deprivation (GIMD quintile 5) compared to municipalities in GIMD quintiles 1-4. In models with interaction effects, we obtained two results: in GIMD quintile 5, distances were longer in rural areas (444-1343 m, or 3-34 % longer), but generally shorter in urban areas (299 m longer to 731 m shorter, or 5-37 % shorter).

Our results for rural areas confirm studies from Germany and Poland, those for urban areas confirm results from England. The diverging interaction effects might be due to locational advantages of urban areas.

The spatial accessibility of general practices was worst for rural municipalities in GIMD quintile 5. It should be evaluated whether the General Practice Planning Reform of 2019 and incentive programmes are able to attenuate this twofold disadvantage.