Title : Geographic disparities in access to emergency healthcare in Hawaii: Rurality, gender, and a multimodal geospatial analysis
Abstract:
For patients experiencing acute medical emergencies, time to definitive care is a direct determinant of survival. In the United States, rural populations face well-documented barriers to reaching emergency facilities within clinically recommended timeframes. Hawaii is an understudied case: its archipelagic geographic, diverse demographic makeup, and documented evidence that rurality is the strongest predictor of health outcomes deem it an important site of inquiry. No study has yet applied a geospatial analysis to estimate emergency healthcare access in the state. This study examines the relationship between rural living and timely access to emergency healthcare across Hawaii, with specific investigations into variability of access across four specialty emergency facilities and the exacerbation of rural access gaps by demographic characteristics. A cross-sectional geospatial analysis using GIS software, Census block group population data, and a multimodal transport model incorporating ground and air ambulance transport calculates access to emergency facilities beyond 30, 45, and 60-minute thresholds. Findings are disaggregated by rurality, using USDA RUCA codes adapted with Hawaii-specific rural classifications, and by demographic characteristics including sex/gender, race/ethnicity, age, income, and disability status. This study hypothesizes that neighbor island and rural O‘ahu populations will face substantially reduced access to specialty emergency facilities, and that rural women of reproductive age will face the most acute gaps, particularly to maternity-capable facilities. These findings will represent the first geospatial evidence of emergency care access disparities in Hawaii, with direct implications for facility designation, inter-island ambulance infrastructure, and rural maternity care policy.
