RURAL IMMUNOLOGY CARE remains significantly less accessible than primary care services for people with primary immune disorders, according to a national analysis of healthcare resources across the USA.
Primary immune disorders, also known as inborn errors of immunity, are associated with delayed diagnosis and limited access to specialist treatment, particularly in rural communities. Researchers sought to quantify geographic access to expert clinical immunologists, infusion centres, and federally qualified health centres to better understand disparities in specialist care.
Publicly available national datasets were analysed to identify expert clinical immunologists and federally qualified health centres across the USA, while infusion centres were evaluated across six states and territories. Rurality was assessed using Rural Urban Commuting Area codes and population density, and geographic information system mapping was used to visualise specialist coverage and two-hour service areas.
The analysis found that federally qualified health centres were well represented in rural areas, accounting for approximately 30% of all centres despite only around 20% of the USA population living in rural communities. By contrast, expert clinical immunologists were underrepresented in rural locations nationally, while both expert clinical immunologists and infusion centres were underrepresented in the six state and territory analysis.
Statistical analyses confirmed significant disparities in specialist distribution. Rural representation of expert clinical immunologists was lower than expected using Rural Urban Commuting Area classifications (r=−2.68), while infusion centres also showed significant rural underrepresentation (r=−2.91).
Geographic information system mapping further demonstrated the limited availability of specialist services, with rural coverage by expert clinical immunologists identified in only six states. Similar findings were observed regardless of how rurality was defined, supporting the consistency of the results.
The researchers concluded that patients with primary immune disorders living in rural communities continue to face substantial barriers to both diagnosis and treatment, despite the availability of primary healthcare services. The contrast between the broad distribution of federally qualified health centres and the limited availability of specialist immunology services suggests that access challenges are driven by shortages in subspecialty care rather than primary care infrastructure.
The findings highlight an urgent need for strategies that improve access to expert clinical immunologists and infusion services in rural regions, with the potential to reduce diagnostic delays and improve care for people with primary immune disorders.
Reference
Blaukovitch JA et al. Geographic Barriers to Subspecialty Care Access for Patients with Primary Immune Disorders in the United States. JACI. 2026.
Image credit: Adobestock/JPC-PROD
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