Betty Nguyen|Fleta N. Bray
Access to dermatologic care in Indigenous American communities
University of Miami|University of California, Riverside|University of Miami
editor american indian alaska native aian tribes united states experience poorer health outcomes compared americans including increased melanoma mortality1wu xc eide mj king j et alracial ethnic variations incidence survival cutaneous melanoma united states 19992006j acad dermatol 2011 65 s26s37pubmed google scholar acne scarring2zullo sw maarouf shi vy acne disparities native americansj acad dermatol 2021 85 499501abstract full text full text pdf pubmed scopus 3 google scholar several factors explain disparity including inadequate health literacy disproportionate poverty cultural differences decreased accessibility dermatologic care although density dermatologists 34 per 100000 individuals across united states risen still less 4 per 100000 individuals recommended achieving sufficient care3glazer farberg winkelmann rr rigel ds analysis trends geographic distribution density us dermatologistsjama dermatol 2017 153 322325crossref pubmed scopus 75 google scholar given undersupply dermatologists geographic variations provider density dermatologists supplemented dermatology physician assistants dpas however remains unclear whether sufficiently improved dermatologic health care accessibility study reports density dermatologists dpas aian homelands explores potential contributing factors health disparities based 2020 decennial united states census 5117371 individuals living 705 aian homelands identified populous 100 homelands 4742579 927 individuals analyzed locations dermatologists dpas obtained american academy dermatology society dermatology physician assistants correlated homeland borders defined census providers located within homeland borders counted 56 dermatologists 3 dpas populous 100 homelands yielding mean dermatology provider density 124 per 100000 individuals 23 homelands least 1 dermatology provider 7 homelands exceeded minimum recommended dermatologist density 4 per 100000 individuals table figure 1 summarize data total numbers densities dermatologists dpas homelandtable inumber dermatology providers practicing within 10 populous 10 providerdense american indian alaska native homelands united statesrankhomelandtotal populationtotal dermatologiststotal dpastotal providersproviders per 100000most populous homelands1creek otsa ok813184160161972cherokee otsa ok5131781010193lumbee sdtsa nc5107113030594chickasaw otsa ok3064604151635choctaw otsa ok2269840000006kiowacomancheapachefort sill apache otsa ok1876461010537cheyenne arapaho otsa ok1866281010548united houma nation sdtsa la1860564042159navajo nation reservation offreservation trust land aznmut16515810106110citizen potawatomi nationabsentee shawnee otsa ok126987000000most providerdense homelands1united cherokee aniyunwiya nation sdtsa al618410116172salt river reservation az632110115823cherocreek sdtsa al850091011112944kawponca jointuse otsa ok261461127655natchitoches sdtsa la265282027546bayou lafourche sdtsa la141951017047kenaitze anvsa ak346372025778uintah ouray reservation offreservation trust land ut251921013979wind river reservation offreservation trust land wy2575910138810kickapoo otsa ok26259101381anvsa alaska native village statistical area dpa dermatology physician assistant otsa oklahoma tribal statistical area sdtsa state designated tribal statistical area open table new tab anvsa alaska native village statistical area dpa dermatology physician assistant otsa oklahoma tribal statistical area sdtsa state designated tribal statistical area access dermatologic care aian communities mirrors least dermatologistdense areas united states likely influenced location rural areas3glazer farberg winkelmann rr rigel ds analysis trends geographic distribution density us dermatologistsjama dermatol 2017 153 322325crossref pubmed scopus 75 google scholar 5 homelands 2 practitioners 5 contained urban center disparity provider density rural metropolitan areas steadily increasing years4feng h berkkrauss j feng pw stein ja comparison dermatologist density urban rural counties united statesjama dermatol 2018 154 12651271crossref pubmed scopus 86 google scholar given shortage dermatologists practicing aian homelands transportation potentially distant dermatology providers remains barrier accessing care one study evaluating dermatologic care rural aian communities median driving distance dermatology clinic tribal hospital 68 miles5morenz wescott mostaghimi sequist td tobey evaluation barriers telehealth programs dermatological care american indian individuals rural communitiesjama dermatol 2019 155 899905crossref pubmed scopus 25 google scholar study several limitations including lack available data nondermatology physicians nonphysician providers eg nurse practitioners practitioners members american academy dermatology society dermatology physician assistants study also unable account dermatology providers practice directly outside aian homeland borders report emphasizes undersupply dermatology providers aian homelands moreover dpas adequately supplemented dermatologic care regions improving practice incentives creating aianfocused residency training tracks promoting rural health programs tribal lands expanding telehealth increasing recruitment medical students dermatology residents aian homelands may improve health care accessibility areas none disclosed