Spatial Access to Vaccines for Children Providers in South Carolina: Implications for HPV Vaccination

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In panel A, rural ZCTAs are in the northeast, southeast, and southwest parts of the state. The central and coastal parts of the state were more urban, and the northwestern part of the state has a mix of rural and urban areas. More VFC locations were in urban ZCTAs. The locations in rural areas often are much further apart and fewer in number in other locations.

In panel B, the age-eligible population (number of children aged <18 years) for VFC programs in each ZCTA is noted by tertile: 0 to 506, 507 to 2,589, and 2,590 to 21,113 persons. Larger age-eligible populations are in the northern ZCTAs, while the southern part of the state has smaller age-eligible populations.

In panel C, spatial accessibility scores, as calculated by using the 2-step floating catchment area method, are shown as high, moderate, or low for both urban and rural areas. Many rural areas are shown to have high access, while large sections of urban areas have low access.

In panel D, cold spots and hot spots are shown with 99% confidence, 95% confidence, and 90% confidence. In most of the state there is no significant difference between urban and rural ZCTAs regarding access to VFC programs. The few hot spots with 99% confidence and 95% confidence are mostly in the southern rural areas that border urban areas in the state. The cold spots with 90% confidence are in urban areas mostly in the central part of the state; there were no cold spots with 95% or 99% confidence.

Panel A shows the location of VFC providers by rural and urban Zip Code Tabulation Areas (ZCTAs). Panel B shows the age-eligible population for the VFC programs by tertiles. Panel C shows spatial accessibility by tertile of accessibility score for both rural and urban ZCTAs. Accessibility was defined as supply (ie, VFC provider locations) of and demand for services (ie, children and adolescents age-eligible for the VFC program) within a specified catchment area (ie, 30 minutes’ drive time). Panel D shows spatial accessibility cold spots and hot spots (areas of low access [cold spots] and high access [hot spots]) across ZCTAs. Sources: South Carolina Department of Health and Environmental Control (VFC data, 2019) and the American Community Survey (2013–2017).

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