Abstract
Purpose :
Cataract surgeries are among the most common ophthalmic procedures in the United States, but disparities in access may foster disease progression. In this nationwide epidemiological study, we characterize county-level variation in cataract surgery access and utilization for Medicare patients.
Methods :
Using the 2019 Medicare Physician & Other Practitioners - by Provider and Service dataset, we identified all ophthalmologists who performed cataract surgeries on Medicare beneficiaries in a United States county. For each surgeon, we calculated the number and type of performed cataract surgeries and identified their county location. Cataracts billed to ambulatory surgical centers were excluded since identifying practice patterns of distinct providers was not possible. We gathered socioeconomic information for each county from U.S. Department of Agriculture datasets. For each county with a cataract surgeon, we identified the number of surgeons per 10,000 Medicare beneficiaries and surgeries per 1,000 Medicare beneficiaries. Multiple linear regression was used to characterize associations between these variables and county characteristics, including measures of poverty, education, and income.
Results :
In 2019, 2,361,653 cataract surgeries were performed by 9,171 surgeons in 1,103 U.S. counties. The average county had 8.3 (SD=16.5) surgeons who each performed 359.6 (SD=572.7) surgeries. For every 1,000 Medicare beneficiaries in the average county, 68.3 (SD=118.5) cataract surgeries were performed. For every 10,000 Medicare beneficiaries in a county, there were 2.0 (SD=1.5) practicing cataract surgeons. Multiple linear regression showed counties with lower rates of employment and high-school graduation had significantly fewer cataract surgeons per 10,000 Medicare beneficiaries and fewer surgeries performed per 1,000 Medicare beneficiaries.
Conclusions :
We uncover significant county-level variation in cataract surgeon access and utilization among Medicare beneficiaries in the United States. Access was improved in areas with more employed individuals or high-school graduates, reflecting known disparities. This information may allow clinicians and policymakers to design targeted interventions that may reduce disparities in access to an important ophthalmic procedure. Further work can focus on identifying whether reduced cataract surgery provision in certain areas leads to increased prevalence of blindness and other ocular complications.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.