Pharmacy Closures and Deserts Disproportionately Affect Racial Minority Communities, BU Study Finds
A Boston University study found pharmacy closures may have an unequal impact, with predominantly white communities having more pharmacies than other racial and ethnic communities. Photo via Shutterstock/mikeledray
Pharmacy Closures and Deserts Disproportionately Affect Racial Minority Communities, BU Study Finds
BU School of Public Health researcher suggests solution may involve coupling new policies and financing programs with payment reform and affordable transportation
For at least 15,000 people in Boston, picking up a prescription is no easy feat—they live in pharmacy deserts, areas of the city without convenient access to a drugstore. And they’re not alone in facing a struggle to access essential medications and care. Nationally, close to 30 percent of retail pharmacies—squeezed by thin profit margins, reduced reimbursement rates, and worker shortages—closed between 2010 and 2021.
A new Boston University study shows these closures are having an unequal impact, disproportionately affecting communities with a majority of racial and ethnic minority residents.
Researchers found that predominantly white communities had more pharmacies—15 percent more per 10,000 people—than other racial and ethnic communities, both before and after the COVID-19 pandemic. The results of the national study were published in JAMA Network Open.
“When a pharmacy is absent in a neighborhood because it closed or was never there, this can create barriers for residents to not only obtain medications, but other essential health services, such as vaccines [and] testing and treatment for multiple diseases and conditions,” says Elaine Nsoesie, a BU School of Public Health associate professor of global health.
When a pharmacy is absent in a neighborhood because it closed or was never there, this can create barriers for residents to not only obtain medications, but other essential health services, such as vaccines [and] testing and treatment for multiple diseases and conditions.
An expert on using data science and technology to advance health equity, she was inspired to study pharmacy deserts after writing a 2024 Boston Globe opinion piece about their impact on Black and Latino communities and receiving a variety of responses from the community. Data indicates that past pharmacy closures have led to a decline in both access and adherence to life-saving medications, including cardiovascular and anti-seizure medicines. Beyond medication pick-up sites, pharmacies have expanded to become trusted community health hubs over the last several decades, and their absence can leave residents with a dearth of resources for other clinical support.
Race and Ethnicity a Stronger Pharmacy Desert Determinant than Income
For the study, Nsoesie and colleagues from SPH and the Thayer School of Engineering at Dartmouth College analyzed data from mobile phones in more than 112,000 census block groups across 45 states and Washington, DC, both pre- and post-pandemic. Examining demographics and pharmacy availability and visits, the team found that predominantly white and diverse neighborhoods had more pharmacies in 2019 and in 2023 than racial-minority neighborhoods. While white and diverse neighborhoods with at least one pharmacy had a higher median household income than neighborhoods with no pharmacies, neighborhoods with a majority of racial and ethnic minority residents had nearly the same median household income in areas with and without pharmacies, suggesting that race and ethnicity might be a stronger determinant of a pharmacy desert than income alone.
Vehicle ownership, percentage of single-family homes, and median age were linked to neighborhoods with an increase in pharmacies per 10,000 people, while percentage of females, increases in median household income, and percentage of residents born outside the US were linked to neighborhoods with a decrease in pharmacies per 10,000 people.
Tracking movement of mobile devices, the researchers also examined frequency of pharmacy visits and found that people in white communities most commonly visited pharmacies in similar neighborhoods, while people in racial and ethnic minority communities with fewer pharmacies tended to utilize pharmacy services in diverse neighborhoods.
Long-Term Solutions that Incorporate Community Needs
The researchers concluded their findings showed “access to pharmacies falls along segregated lines,” noting that residential segregation is an established influence on health. Previous studies have recommended the use of economic incentives and the integration of pharmacies into community health centers as potential solutions to redress the balance, but Nsoesie and her colleagues also suggest payment reforms and affordable transportation could help expand drugstore availability and access.
“Researchers have written about the need to develop policies and financing programs that encourage pharmacies to be located in pharmacy deserts,” says Nsoesie, a member of the BU Faculty of Computing & Data Sciences and a data science faculty fellow. “We suggest that such policies could be coupled with affordable and accessible transportation. However, any long-term solutions should consider the specific needs of the local community to ensure that solutions are effective.”
This research was supported by a gift from MassMutual to the BU Faculty of Computing & Data Sciences.