Dermatology access in distressed communities: Exploring the impact of community economic hardship on care availability

Summary: Abstract Body: This study examines how community economic distress influences access to dermatology care, focusing on three clinic-level factors: clinic operating hours, teledermatology availability, and Medicaid acceptance. The Distressed Communities Index (DCI), a composite measure that combines indicators of economic distress such as income, employment, education, and housing, was used to categorize communities into quintiles, from the most prosperous (1) to the most distressed (5). In this cross-sectional study, 122 medical dermatology clinics in the southern United States were categorized by DCI quintile and contacted for data on operating hours, teledermatology availability, and Medicaid acceptance in August 2024. Clinics in more distressed communities had fewer access opportunities. Operating hours decreased by 1.3 hours per week with each increase in DCI quintile (β = -1.34, p < 0.001), with the most distressed areas operating 5.4 fewer hours weekly than the most prosperous areas (36.1 vs. 41.5 hours, respectively). The proportion of clinics offering teledermatology also decreased by 6.4% per quintile (β = -6.36, p = 0.003), showing a 25.4% decline from prosperous areas (where 54.8% of clinics offered teledermatology) to distressed areas (where only 29.3% of clinics offered teledermatology). Medicaid acceptance did not significantly vary across DCI quintiles (p = 0.074). These findings demonstrate how economic distress limits access to dermatology care, particularly in underserved communities. Expanding teledermatology, optimizing clinic hours, and implementing innovative solutions such as mobile units and AI-driven triage systems could help reduce barriers and enhance dermatology healthcare equity in economically distressed regions of the United States and globally. Charlotte McRae¹, Ella Nichols¹, Connor Sisk¹, Laci Turner¹, Michael Anderson¹, Rohit Reddy¹, Tiffany Mayo¹ 1. The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States. Clinical Research: Epidemiology and Observational Research