USING THE INDEX OF CONCENTRATION AT THE EXTREMES TO MEASURE THE ASSOCIATION BETWEEN SPATIAL POLARIZATION AND DISTANCE TRAVELED FOR CARE IN A COLORADO CLINIC

Abstract

Objectives

We aimed to assess changes in geographical segregation and distance traveled for abortion, after Dobbs v Jackson Women’s Health Organization allowed states to implement greater abortion care restrictions, using the Index of Concentration at the Extremes (ICE), which quantifies extremes of disadvantage and privilege.

Methods

Data included all individuals obtaining an abortion at a university-affiliated clinic in Denver, CO between July 2021 and June 2023. We created two time periods: before (July 2021–June 2022) and after Dobbs (July 2022–June 2023). We compared ICE quintile distributions for individuals traveling >100 and >300 miles (vs. <100 and <300 miles, respectively) before and after Dobbs using chi-squared tests. We used logistic regression to determine the independent predictors of traveling >100 miles and >300 miles for abortion care adjusting for time period.

Results

We assessed 2,709 total abortions: 1,391 before and 1,318 after Dobbs. The proportion of individuals traveling >100 miles for abortion care increased from 22.57% to 36.72% (p<0.001), and those traveling >300 miles increased from 16.82% to 33.69% (p<0.001). In logistic regression, individuals in the most disadvantaged ICE quintile had 8.58 (adjusted OR (aOR); 95% CI [6.14 - 11.98]) times adjusted odds of traveling >100 miles and 9.04 (aOR; 95% CI [6.33 - 12.90]) times adjusted odds of traveling >300 miles for abortion care versus those in the least-disadvantaged ICE quintile and the odds of traveling >300 miles increased by 2.52 (aOR; 95% CI [2.08 - 3.04]) post Dobbs.

Conclusions

Abortion bans add to undue burden by increasing distance traveled for in-person care. These bans disproportionately impact communities already facing socioeconomic structural discrimination.