1021 Impact of Income Inequality on Neurosurgeon Distribution Across U.S. Counties

INTRODUCTION: Equitable healthcare distribution is essential, yet socioeconomic disparities often impact the availability of specialty medical services. This study examines how income inequality affects neurosurgeon distribution in U.S. counties. METHODS: We utilized the 2021 CDC Interactive Atlas of Heart Disease and Stroke to gather data on the distribution of neurosurgeons across U.S. counties. Additionally, demographic and socioeconomic data for each county were obtained from the U.S. Census Bureau county profiles. Income inequality was calculated using the Gini index. RESULTS: Among 437 U.S. counties with at least one practicing neurosurgeon, 72 exhibited a Gini index above the national average, reflecting higher income inequality. These counties had a significantly higher proportion of non-Hispanic Black (18.29% vs. 7.99%, P<0.001) and Hispanic residents (21.37% vs. 13.22%, P<0.001) compared to counties with lower income inequality. Additionally, these high inequality counties also reported higher poverty rates (15.76% vs. 11.64%, P<0.001) and a greater percentage of residents without health insurance (10.80% vs. 9.22%, P=0.007). Furthermore, these areas had fewer healthcare facilities; on average, there were fewer hospitals (2.66 vs. 5.54, P<0.001) and fewer hospitals providing specialized neurological services (1.58 vs. 3.58, P<0.001). The analysis underscored a significant disparity in the availability of neurosurgeons in high income inequality counties, with these regions being three times more likely to be underrepresented by neurosurgeons (OR 3.49, 95%CI 1.68-7.25, P<0.001). This relationship persisted even after adjusting for various demographic and socioeconomic factors. CONCLUSIONS: The study underscores significant disparities in neurosurgeon distribution linked to income inequality, with higher inequality associated with fewer healthcare resources and greater demographic challenges. Enhanced policy measures are needed to improve healthcare access and infrastructure in underserved areas.