3C-11 - Trends and Disparities in Pharmacy Shortage Areas in Urban, Suburban,and Rural Neighborhoods in the U.S.

Background: Pharmacies are essential community healthcare resources, providing vital medications and preventive care. Despite the growing problem of pharmacy closures and evidence of disparities in pharmacy access, up to date information is lacking.

Objectives: We characterize trends and disparities in pharmacy shortage areas (PSAs) across urban, rural and suburban neighborhoods in the United States between 2010 and 2024.

Methods: We used pharmacy data from the National Council for Prescription Drug Programs (2010 - 24) and neighborhood characteristics from the five-year American Community Survey (2018 - 22). For each year, the average distance between a census block group’s population-weighted centroid and its nearest pharmacy was calculated for each census-tract (i.e. neighborhood). We calculated a population-weighted average of these distances for each census tract. If the population-weighted distance to nearest pharmacy was ≥1 mile in urban tracts , ≥2 miles in suburban tracts, or ≥10 in rural tracts , we classified the tract as a PSA. In all neighborhods identified as low-vehicle ownership and low-income we used a threshold of 0.5 miles. Logistic regression models assessed the association between neighborhood characteristics and year with PSAs.

Results: The number of operating retail pharmacies declined from a peak of 67,164 in 2016 to 63,052 in 2024. Overall, the prevalence of pharmacy shortage areas remained stable between 2010 and 2024, but it increased in Black and Indigenous majority neighborhoods. In 2024, 12.5% of neighborhoods in the US were PSAs. Importantly, 46.3% of pharmacy shortage area tracts were also identified as medically underserved areas (MUAs). Black (32.7%), Latinx (16.1%), and Indigenous (74.7%) majority neighborhoods were more likely to be PSAs compared to White majority neighborhoods (9%). These disparities have worsened over time driven by increasing PSAs in urban, Black majority neighborhoods where 15.9% experienced the closure of a nearest pharmacy.

Conclusions: As of 2024, more than 1 in 10 neighborhoods are pharmacy shortage areas, affecting 12% of Americans. We found persistent disparities in pharmacy shortage areas which have worsened due to pharmacy closures that disproportionately affect Black neighborhoods. Persistent inequities may contribute to poor access and low adherence to medication.