University of Miami Miller School of Medicine, Miami, Florida.
University of Miami, Miami, Florida.
JAMA Ophthalmol. 2023 Mar 1;141(3):242-249. doi: 10.1001/jamaophthalmol.2022.6010.
The geographic distribution of pediatric ophthalmological care has not been reported on since 2007; understanding this distribution could shed light on potential avenues to increase access, which is a necessary first step in addressing the pediatric ophthalmological needs of underserved areas.
To analyze the number and location (ie, geographic distribution) of pediatric ophthalmologists in relation to US population demographic characteristics.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, public databases from the American Academy of Ophthalmology and American Association for Pediatric Ophthalmology and Strabismus were used to identify pediatric ophthalmologists in the US as of March 2022.
Geographic distribution of pediatric ophthalmologists listed in public databases and any association between pediatric ophthalmologist distribution and US population demographic characteristics. Addresses were geocoded using ArcGIS Pro (Esri).
A total of 1056 pediatric ophthalmologists (611 men [57.9%]) were identified. States with the most pediatric ophthalmologists were California (n = 116 [11.0%]), New York (n = 97 [9.2%]), Florida (n = 69 [6.5%]), and Texas (n = 62 [5.9%]), the 4 most populous states. A total of 2828 of 3142 counties (90.0%) and 4 of 50 states (8.0%) had 0 pediatric ophthalmologists. In 314 counties (10.0%) with 1 or more pediatric ophthalmologists, the mean (range) pediatric ophthalmologists per million persons was 7.7 (0.4-185.5). The range of practitioner to million persons has increased since 2007. Counties with 1 or more pediatric ophthalmologists had a higher median (SD) household income compared with counties with 0 pediatric ophthalmologists ($70 230.59 [$18 945.05] vs $53 263.62 [$12 786.07]; difference, -$16 966.97; 95% CI, -$18 544.57 to -$14 389.37; P < .001). Additionally, the proportion of families in each county without internet service (8.0% vs 4.7%; difference, 3.4%; 95% CI, 3.0%-3.7%; P < .001), the proportion of persons younger than 19 years without health insurance (5.7% vs 4.1%; difference, 1.6%; 95% CI, 1.1%-2.2%; P < .001), and the proportion of households without vehicle access (2.1% vs 1.8%; difference, 0.3%; 95% CI, 0.6%-5.2%; P = .001) were greater in counties with 0 compared with counties with 1 or more pediatric ophthalmologists.
This cross-sectional study found that disparities in access to pediatric ophthalmological care have increased over the past 15 years and are associated with lower socioeconomic status. As patients may rely on online sources to identify the nearest pediatric ophthalmologist, accurate publicly available databases are important.
自 2007 年以来，尚未报道儿科眼科护理的地理分布情况；了解这种分布情况可以揭示增加获取途径的潜在途径，这是解决服务不足地区儿科眼科需求的必要第一步。
分析美国儿科眼科医生的数量和位置（即地理分布）与美国人口人口统计学特征的关系。
设计、地点和参与者：在这项横断面研究中，使用美国眼科学会和美国儿科眼科学会和斜视协会的公共数据库，确定截至 2022 年 3 月美国的儿科眼科医生。
公共数据库中列出的儿科眼科医生的地理分布情况，以及儿科眼科医生分布与美国人口人口统计学特征之间的任何关联。使用 ArcGIS Pro（Esri）对地址进行地理编码。
共确定了 1056 名儿科眼科医生（611 名男性[57.9%]）。儿科眼科医生数量最多的州是加利福尼亚州（n=116[11.0%]）、纽约州（n=97[9.2%]）、佛罗里达州（n=69[6.5%]）和德克萨斯州（n=62[5.9%]），这是 4 个人口最多的州。共有 2828 个县（90.0%）和 50 个州中的 4 个（8.0%）没有 1 名儿科眼科医生。在 314 个有 1 名或多名儿科眼科医生的县中，每百万人的平均（范围）儿科眼科医生人数为 7.7（0.4-185.5）。自 2007 年以来，执业医生与每百万人的比例有所增加。有 1 名或多名儿科眼科医生的县的家庭中位数（标准差）收入高于没有儿科眼科医生的县（$70230.59 [$18945.05]与$53263.62 [$12786.07]；差异，$-16966.97；95%CI，$-18544.57 至$-14389.37$；P<0.001）。此外，每个县没有互联网服务的家庭比例（8.0%比 4.7%；差异，3.4%；95%CI，3.0%-3.7%；P<0.001），19 岁以下没有医疗保险的人的比例（5.7%比 4.1%；差异，1.6%；95%CI，1.1%-2.2%；P<0.001），以及没有车辆通行的家庭比例（2.1%比 1.8%；差异，0.3%；95%CI，0.6%-5.2%；P=0.001）在没有 1 名或多名儿科眼科医生的县中更高。
这项横断面研究发现，过去 15 年来，儿科眼科护理获取方面的差距有所扩大，且与社会经济地位较低有关。由于患者可能依赖在线资源来识别最近的儿科眼科医生，因此准确的公共可用数据库非常重要。
