A Spatial-Statistical Framework for Analyzing Territorial Inequalities in Pharmacy Access: Integrated Evidence from Milan and Taranto

The equitable distribution of essential community services is a critical component of urban well-being and a key social indicator of quality of life. While Italy maintains a high overall density of pharmacies, their intra-municipal allocation can generate significant disparities in access. This study examines the territorial distribution of community pharmacies in two structurally different Italian cities, Milan and Taranto. Using ISTAT census data, municipal open data and GIS, we combine census-section mapping with binomial logistic regression for pharmacy presence and a separate spatial autologistic model for high socio-economic deprivation. The pharmacy-presence models show different associations with the Caranci deprivation index across the two cities: positive in Milan (estimate = 0.1449, p < 0.001) and negative in Taranto (estimate=-0.298, p = 0.008). In the high-deprivation models, the spatial-lag term is strongly associated with high deprivation in both Milan (OR = 3.95, p < 0.001) and Taranto (OR = 4.21, p < 0.001). The census-section framework was also applied in Taranto to support an administrative decentralization process for pharmaceutical services by resolving ambiguities in population allocation and providing an objective basis for policy planning. The findings show that pharmacy accessibility and deprivation have city-specific relationships and that fine-grained territorial units can improve evidence-based planning of essential services.