School of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.
Ophthalmic Epidemiol. 2024 Apr;31(2):152-158. doi: 10.1080/09286586.2023.2216286. Epub 2023 May 25.
The eye exam is a critical tool for the prevention, screening, and diagnosis of ocular and systemic conditions. In this study, we characterize county-level variation in eye exam access and utilization for Medicare patients in the United States.
This nationwide study uses the Medicare Physician & Other Practitioners - by Provider and Service dataset. We included all ophthalmologists and optometrists who performed eye exams on Medicare beneficiaries within a United States county in 2019. For every county where exams were performed, we calculated the number of practicing vision testing providers, percentage of providers classified as ophthalmologists, and the number of exams per 100 Medicare beneficiaries. Multiple linear regression was used to characterize associations between these variables and county characteristics, including measures of poverty, education, and income.
In 2019, 28937,540 eye exams were performed by 46,000 providers in 2,291 U.S. counties. In the median county, 34.9 eye exams were provided per 100 Medicare beneficiaries. The average county had 20.1 exam providers, 16.5% of whom were ophthalmologists. There were a median 6.6 eye exam providers for every 10,000 Medicare beneficiaries in the average county. The average provider performed 517.8 exams. Regression showed counties with lower median household incomes, higher poverty rates, or fewer high-school graduates had fewer eye exam providers per 10,000 Medicare beneficiaries and fewer eye exams performed per 100 Medicare beneficiaries.
We find significant county-level variation in eye exam utilization and provider availability. This reflects broader, well-recognized trends in socioeconomic health disparities in the U.S.
眼部检查是预防、筛查和诊断眼部和全身疾病的重要工具。本研究旨在描述美国 Medicare 患者眼部检查的可及性和利用情况在县一级的差异。
本研究为全国性研究，使用 Medicare 医师和其他从业者-按提供者和服务数据集。我们纳入了 2019 年在美国县内为 Medicare 受益人行眼部检查的所有眼科医生和验光师。对于进行过检查的每个县，我们计算了进行视力检查的执业者人数、被归类为眼科医生的提供者比例，以及每 100 名 Medicare 受益人的检查次数。采用多元线性回归分析来描述这些变量与县特征之间的关联，包括贫困、教育和收入等指标。
2019 年，在美国 2291 个县由 46000 名医生进行了 28937540 次眼部检查。在中位数县，每 100 名 Medicare 受益人的检查次数为 34.9 次。平均每个县有 20.1 名检查提供者，其中 16.5%为眼科医生。在平均每个县的每 10000 名 Medicare 受益人中，有 6.6 名眼科检查提供者。平均每个提供者进行了 517.8 次检查。回归分析显示，家庭收入中位数较低、贫困率较高或高中毕业生较少的县，每 10000 名 Medicare 受益人的眼科检查提供者较少，每 100 名 Medicare 受益人的眼部检查次数也较少。
我们发现眼部检查的利用和提供者的可及性存在显著的县一级差异。这反映了美国社会经济健康差异的更广泛、众所周知的趋势。
