DISP-18. Distribution of pituitary tumor surgeons in the united states predicts community-level social vulnerability and barriers to access

Pituitary adenomas often require urgent surgical intervention to prevent irreversible visual or hormonal dysfunction. Yet, access to experienced pituitary surgeons remains highly centralized. We analyzed national patterns in provider distribution and travel burden, identifying geographic and sociodemographic factors that limit timely access to specialized surgical care. We performed a cross-sectional geospatial and sociodemographic analysis across 40 U.S. County catchment areas. Pituitary surgeons were identified from CMS billing data as providers who submitted ≥10 annual claims for CPT codes 62165, 61546, or 61548 over five years. Provider locations were geocoded to define access points. County-level demographic and health data were obtained from the UCSF Health Atlas. Two primary outcomes were calculated: mean Euclidean distance to the nearest pituitary surgeon and surgeon density per 100,000 population. Multivariate linear regression models identified predictors of both outcomes. Among 83 identified pituitary surgeons, access varied markedly across regions. Travel distances ranged from 5.9 to over 150 miles. A multivariate model (adjusted R² = 0.706, p < 0.001) revealed that higher proportions of Native American residents predicted significantly longer travel distances (β = +18.2 miles per 1%, p < 0.00001), alongside cognitive disability prevalence, depression, lack of vehicle access, and poor internet infrastructure (p < 0.05). Surgeon density was positively associated with population density, income, education, and vehicle access. Latino-majority regions had significantly fewer providers per capita (β = -0.059, p < 0.01). Substantial disparities exist in access to pituitary surgery, driven by overlapping social, economic, and geographic barriers. Native American and socioeconomically disadvantaged populations face the longest travel distances, while wealthier urban areas benefit from greater provider density. Interventions such as telehealth, transportation support, and workforce redistribution are needed to address these inequities.