Geographic Variations in Referrals to a Tertiary Uveitis Center in the Southeast United States

Abstract

 

Purpose

 

To determine whether variations exist in the geographic distribution of uveitis diagnoses seen at a regional referral center.

 

Methods

 

Retrospective review of cases seen between 2007 and 2009 inclusive at the University of Alabama at Birmingham, a tertiary referral center. De-identified zip code data was matched with diagnoses and anatomical categorization. Google Fusion Tables and Batchgeo.com were used to construct geographic representations of the distribution of uveitis diagnoses and anatomical disease categories.

 

Results

 

412 patients had clinical data and a matching zip code available. Of these, 279 were female (68%), 178 were African American (43%), 224 were Caucasian (54%), and the remainder were Latino, Asian, or of mixed heritage. Anterior uveitis comprised 252 (61%) of cases, 40 were intermediate or anterior & intermediate (9.7%), 47 were posterior uveitis (11%), and 73 (18%) were panuveitis. The geographic distribution of anatomical category varied by zip code, with the urban areas closest to the study center having more anterior disease, while individuals from urban areas more distant had a greater proportion of anatomical cases of other than anterior disease (Figure 1). Idiopathic disease was the most common “diagnosis” in all geographic areas, but the make up of other diagnoses varied, though in no specific pattern (Figure 2).

 

Conclusions

 

The anatomical category of uveitis presenting to a regional referral center appears to vary based on the distance from the referral center the patient lives. Possible explanations for this are that anterior disease may be considered milder and thus not worthy of distant referral by the local treating physician; that patients with anterior disease distant from the referral center may have more difficulty in or be more resistant to travel; that ethnic clustering of populations results in similar clustering of diagnoses; or that geography, with its attendant variations in environmental exposure and genetic makeup of it population, does result in a difference in disease.

 

 

Geographic distribution of uveitis cases by anatomical category. Legend, Red = Anterior, Blue = Panuveitis, Green = Posterior, Yellow = Anterior and Intermediate, Purple = Intermediate.

 

 

Geographic distribution of associated diagnosis. Legend, Red = Idiopathic, Blue = HLA-B27, Green = HZO, Yellow = Persistent postoperative, Purple = Sarcoid, Light Blue = Juvenile arthritis.

 

Keywords: 746 uveitis-clinical/animal model • 463 clinical (human) or epidemiologic studies: prevalence/incidence