Spatial-Structural Disparities in Acute Care Accessibility Among Latin American Immigrants and Spanish Speakers in the Rural US South.

Given that rural hospital closures in the USA have increasingly occurred in rural communities with higher-than-median shares of Latinx residents, this study examines disparities in travel times to access acute hospitals at the nexus of ethnicity (Latinx), nativity status (immigrant status), and language status (Spanish speakers; degree of English proficiency among those whose primary language is Spanish). While the share of Latin American residents (both native- and foreign-born) was not significantly associated with spatial access to both nearest and next nearest hospital, the share of Latin American immigrants was associated with greater travel distances. Overall, travel times to the nearest acute hospital increased incrementally as the tract-level proportion of Latin American immigrants increased. Applying generalized linear mixed models, we tested whether rural census tracts with higher shares of Latin American immigrants, higher shares of Spanish-speaking residents, and higher shares of Spanish speaking residents who speak English "less than well" have greater travel times to access their nearest and next nearest hospital. Per model results, tracts with higher shares of Spanish speaking residents who speak English "less than well" have significantly longer travel distances to access their nearest hospital (β = 10.495; p < .001; 95% CI 0.853-20.137). Finally, compared to tracts with a low share of Latin American immigrant residents, those with moderate shares (30-59.9%) of immigrants from Latin America had longer drive times to their next nearest hospital (β = 1.824; p = 0.004; 95% CI 0.573-3.076). These findings are notable because the South has high rates of hospital bypass.