Geographical Inequalities in Healthcare Accessibility: A Network Analysis of Rural and Peri-Urban Communities

Abstract

Geographical accessibility is also a key element of equitable health service provision, especially in situations where pathways and distances to services are different between rural and peri-urban communities, and where settlement patterns differ. This study examined geographical inequalities in healthcare accessibility by classifying communities according to network-derived travel characteristics, comparing accessibility between rural and peri-urban communities, and estimating the adjusted relationship between driving distance and travel time. A quantitative cross-sectional analysis was conducted using community-level walking and driving time and distance measures from Spain. Following data cleaning and removal of implausible routing records, 36,471 observations were analysed. K-means clustering was applied to classify communities, while Mann–Whitney U tests, Spearman correlation, variance inflation factor analysis, and HC3 heteroskedasticity-robust regression were used for statistical evaluation. The final two-cluster solution classified 59.55% of communities as peri-urban and 40.45% as rural. Rural communities exhibited significantly longer walking and driving times and greater travel distances than peri-urban communities (all p < 0.001), with uniformly large effect sizes (r = 0.841–0.848). The regression model explained 85.9% of the variation in driving time, demonstrating that each additional kilometer increased travel time by 0.987 minutes, while rural communities required an adjusted additional 3.423 minutes. The results indicate that there are still geographical disparities in access to healthcare and show that network-based indicators of access are a strong basis for defining the sub-populations that are lacking in services and for deriving evidence-based territorial plans for health services.