Geographic disparities in rehabilitation provider availability and community demographics in Texas: a cross-sectional geographic information systems study

IMPORTANCE: Availability of rehabilitation providers is a critical component of access to care, yet little is known about how workforce supply relates to community demographic characteristics within urban and rural regions. OBJECTIVE: The objective of this study was to examine geographic variability in the availability of licensed physical and occupational therapy providers in Texas and evaluate the relationship between provider supply and community-level characteristics including race and ethnicity, disability, and poverty. DESIGN: The study used a descriptive, cross-sectional observational study design. SETTING: The setting was all 6896 census tracts across the state of Texas. PARTICIPANTS: Participants included all physical therapists, physical therapy assistants, occupational therapists, and occupational therapy assistants who held a license in 2022 and resided in Texas. INTERVENTIONS/EXPOSURES: Provider workforce supply was derived from state licensure records and linked to population-level demographic and socioeconomic data from the American Community Survey using geospatial analysis. MAIN OUTCOMES AND MEASURES: The population-to-provider ratio for physical therapy and occupational therapy providers per census tract and its relationship to community demographics was the main outcome measure. RESULTS: Among 45,114 licensed physical therapy and occupational therapy providers, provider availability varied widely across Texas census tracts, with population-to-provider ratios ranging from 4 to 11,147 individuals per provider. Bivariate mapping showed that census tracts with fewer providers often overlapped with areas of higher disability prevalence, larger proportions of Hispanic or non-White residents, and higher poverty rates, particularly along southern and border regions and within parts of urban centers like southern Dallas and eastern Houston. Statistical comparisons revealed significant differences in racial composition between areas with the highest and lowest provider availability (χ26 = 1,561,831; Cramér V = 0.36) and in ethnic composition (χ2₁ = 1,012,990; Cramér V = 0.29). Differences in poverty (χ2₁ = 38,746; Cramér V = 0.06) and disability prevalence (χ2₁ = 5175.9; Cramér V = 0.02) were also significant but had smaller effect sizes. CONCLUSIONS: Substantial geographic variability exists in rehabilitation provider supply across census tracts in Texas, with lower availability in areas where populations may have higher needs. These findings highlight opportunities for workforce planning and targeted resource allocation to improve access to rehabilitation services in underserved regions. RELEVANCE: Understanding provider shortages at the census tract level combined with specific community demographics can inform workforce policy development, and initiatives to strengthen the rehabilitation workforce to meet population health needs. Addressing workforce diversity could improve access, patient-provider relationships, and culturally relevant care.