Abstract
Purpose :
To examine the association between rural versus urban residence and the prevalence of chronic eye diseases (CED), including glaucoma, cataract, age-related macular degeneration (AMD) and diabetic retinopathy (DR) among California (CA) Medicare beneficiaries.
Methods :
We analyzed the entire population of 2019 California Medicare fee-for-service beneficiaries using administrative claims files from the Centers for Medicare & Medicaid Services. Beneficiaries were included if they resided in CA, were 65 years or older, were enrolled in Medicare Parts A & B, and had a valid CA ZIP code. The primary exposure was urban or rural residence, determined by residence ZIP codes using Health Resources and Services Administration list of rural counties designated eligible census tracts and the Social Security Administration mapped to Federal Information Processing Series state and county crosswalk files. The primary outcome was prevalence of cataract, glaucoma, AMD and DR based on ICD-10 diagnosis codes. The association between residence type and any CED and its subtypes (glaucoma, cataract, AMD and DR) was assessed using separate multivariable logistic regression models adjusting for age, sex, race and ethnicity and Charlson Comorbidity Index score as a proxy for systemic disease burden.
Results :
The study sample included 5,853,188 California Medicare beneficiaries. A total of 1,375,107 (23.5%) beneficiaries resided in rural ZIP codes. The overall prevalence of any CED was 17.1% (n=997,997). Cataract prevalence was 11.8% (n=688,745), glaucoma prevalence was 7.0% (n=410,885), AMD prevalence was 3.5% (n=202,027), and DR prevalence was 89,648 (1.5%). Rural residence was associated with greater adjusted odds of any CED (adjusted odds ratio [aOR]: 1.17, 95% confidence interval [CI]: 1.16-1.18). Rural residence was also associated with greater adjusted odds of each individual CED, including cataract (aOR: 1.16, 95% CI: 1.15-1.17), glaucoma (aOR: 1.03, 95% CI: 1.03-1.04), AMD (aOR: 1.11, 95% CI: 1.10-1.12) and DR (aOR: 1.17, 95% CI: 1.15-1.19).
Conclusions :
In 2019, Medicare beneficiaries who resided in rural areas of California had increased likelihood of any CED and each individual CED, including cataract, glaucoma, AMD and diabetic retinopathy compared to beneficiaries in non-rural areas. Further studies are needed to characterize and understand the effects of geography on disparities in CED and access to eye care.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.