Pharmacies across the United States continue to close at a rapid rate, leaving millions of Americans in "pharmacy deserts," where they lack convenient and reasonable access to the care these community health hubs provide. Past research indicates that nearly 1 in 3 pharmacies closed between 2010-2021, including more than 7,000 pharmacies since 2019.
A new study led by researchers at Boston University School of Public Health (BUSPH) shows that these closures are occurring disproportionately among communities with a majority of racial and ethnic minority residents.
Published in JAMA Network Open , the nationwide study found that predominantly White communities (defined by census block group) had more pharmacies than other racial and ethnic communities, both before and after the COVID-19 pandemic. Predominantly White neighborhoods had 15 percent more pharmacies per 10,000 people than neighborhoods with predominantly minority populations. 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 other racial and ethnic minority communities with fewer pharmacies tended to utilize pharmacy services in diverse neighborhoods, instead.
This unprecedented decline in pharmacy closures across the US is more than an inconvenience to community members; it may also lead to negative health outcomes. Data indicates that past pharmacy closures have led to a decline in both access and adherence to life-saving medications, including cardiovascular medicine and anticonvulsant medicine . Beyond medication pick-up sites, pharmacies have expanded to become trusted community health hubs over the last several decades, and these shutterings are leaving residents with a dearth of local resources for other clinical support.
"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, testing and treatment for multiple diseases and conditions, and other health services," says study lead and corresponding author Dr. Elaine Nsoesie , associate professor of global health at BUSPH, who was inspired to study pharmacy availability and visits after writing a 2024 opinion piece about the impact of pharmacy deserts on Black and Latino communities in The Boston Globe and receiving a variety of responses from the community. "Our findings show that individuals from predominantly Black and other racial-minority areas might prefer to visit pharmacies in diverse neighborhoods, if they do not have an available pharmacy."
For the study, Dr. Nsoesie and colleagues from BUSPH and The Thayer School of Engineering at Dartmouth College analyzed mobility data from mobile phones in more than 112,000 census block groups across 45 states and Washington, DC between January 2019-January 2020 (before the pandemic) and from January 2023-January 2024 (after the acute phase of the pandemic). Examining demographics, 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.
A number of factors are driving these closures, including thin profit margins , reduced reimbursement rates for medications, and a workforce shortage. The researchers hope this insight emphasizes the need to combine financial reforms with practical local policies that make it easier for residents in pharmacy deserts to access the medicines and care they need.
"Researchers have written about the need to develop policies and financing programs that encourage pharmacies to be located in pharmacy deserts," Dr. Nsoesie says. "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."
The study was coauthored by Andrew Philips, research fellow at BUSPH at the time of the study; Dr. Nina Cesare, research scientist in the Biostatistics and Epidemiology Data Analytics Center at BUSPH; and Zou Yang, a PhD student at The Thayer School of Engineering at Dartmouth at the time of the study.
