Abstract
Purpose :
To examine if geographic access to surgical treatment for glaucoma and cataracts varies among Medicare beneficiaries living in rural or urban California
Methods :
This was a cross-sectional study of the 2017 California (CA) Medicare population. We included beneficiaries with glaucoma or cataracts using ICD-10 diagnosis codes. Beneficiaries were included if they resided in CA in 2017, were 65 years or older, had at least one Part B claim, and a valid CA ZIP code.
Urban or rural residence was determined by ZIP codes using the Health Resources and Services Administration definitions. Distance travelled to eye care providers was measured between patients’ and providers’ ZIP codes with ArcGIS. Multivariable linear regression models were performed to compare mean distance travelled to surgery by urban versus rural residence, controlling for age, sex, race/ethnicity and Charlson Comorbidity Index score. Multivariable logistic regression models were used to assess the effect of travel distance on the odds of receiving glaucoma or cataract surgery, controlling for the covariates above.
Results :
The study sample included 336,117 glaucoma patients, of whom 82,583 (24.6%) were rural residents and 445,164 cataract patients of whom 127,314 (28.6%) were rural residents. A total of 24,324 (7.2%) patients received glaucoma surgery and 93,460 (21.0%) patients received cataract surgery. In adjusted analyses, beneficiaries in rural regions travelled 14.7 miles more (95% confidence interval [CI]: 13.8 to 15.7) for glaucoma surgery and 9.7 miles more (95% CI: 9.3 to 10.2) for cataract surgery than their urban counterparts. For every additional 100 miles travelled, the odds of cataract surgery decreased by 14% (OR: 0.86, 95% CI: 0.84 to 0.87). However, the odds of glaucoma surgery increased by 13% (OR: 1.13, 95% CI: 1.09 to 1.16) for every additional 100 miles travelled.
Conclusions :
In 2017, Medicare beneficiaries who resided in rural California travelled farther to undergo their cataract and glaucoma surgery than beneficiaries in non-rural areas. Longer travel distance was associated with lower odds of cataract surgery, and, paradoxically, was also associated with greater odds of glaucoma surgery. This perhaps points toward the lack of glaucoma subspecialists in rural areas which necessitates further travel; however, additional studies are needed to understand such complex relationships.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.