Choudhry Hassaam S, Patel Riya H, Salloum Lana, McCloskey Jack, Goshe Jeffrey M
Department of Ophthalmology & Visual Sciences, Rutgers New Jersey Medical School, Newark, NJ, USA.
Department of Ophthalmology Visual Sciences, Albert Einstein College of Medicine, New York, NY, USA.
Ophthalmic Epidemiol. 2025 Aug;32(4):412-419. doi: 10.1080/09286586.2024.2406503. Epub 2024 Oct 10.
The Area Deprivation Index (ADI) is a quantitative measurement of neighborhood socioeconomic disadvantage used to identify high-risk communities. The distribution of physicians with respect to ADI can indicate decreased healthcare access in deprived neighborhoods. This study applies ADI to the distribution of ophthalmologists and demonstrates how practice patterns in the national Medicare Part D program may vary with ADI.
The Centers for Medicare and Medicaid Services Data "Medicare Part D Prescribers by Provider" data for 2021 was analyzed. Geocodio identified ADIs corresponding to the practice addresses listed in the dataset. The national rank ADIs were compared against the number of ophthalmologists. Spearman's correlation test and one-way ANOVA determined statistically significant differences in Medicare data extracted between quintiles of ADI ranks.
We identified 14,668 ophthalmologists who provided care to Medicare beneficiaries. Each time ADI increased by 10, there was an average 9.4% decrease in ophthalmologists ( < 0.001). The distribution of ophthalmologists practicing throughout the United States by increasing ADI quintile are: 32%, 23%, 19%, 16%, and 9%. Providers practicing in neighborhoods in the first-ADI quintile were more likely to see Medicare beneficiaries compared to providers in the fifth-ADI quintile ( < 0.001).
The lack of ophthalmologists in high-ADI areas results in reduced eye care access in deprived neighborhoods. Many factors contribute to these disparities including limited access to metropolitan areas/academic institutions and fewer residency programs. Future programs and policies should focus efforts on creating an even distribution of ophthalmologists across the United States and improving access to eye care.
地区贫困指数（ADI）是一种用于识别高风险社区的邻里社会经济劣势的定量测量方法。医生相对于ADI的分布情况可以表明贫困社区的医疗服务可及性降低。本研究将ADI应用于眼科医生的分布情况，并展示了国家医疗保险D部分计划中的执业模式可能如何随ADI而变化。
分析了医疗保险和医疗补助服务中心2021年的数据“按提供者划分的医疗保险D部分开处方者”数据。Geocodio确定了与数据集中列出的执业地址相对应的ADI。将全国排名ADI与眼科医生数量进行比较。Spearman相关性检验和单因素方差分析确定了在ADI排名五分位数之间提取的医疗保险数据中的统计学显著差异。
我们确定了14668名向医疗保险受益人提供护理的眼科医生。ADI每增加10，眼科医生的数量平均减少9.4%（<0.001）。随着ADI五分位数的增加，在美国各地执业的眼科医生分布情况为：32%、23%、19%、16%和9%。与ADI第五五分位数的提供者相比，在ADI第一五分位数社区执业的提供者更有可能诊治医疗保险受益人（<0.001）。
高ADI地区眼科医生的短缺导致贫困社区的眼部护理可及性降低。许多因素导致了这些差异，包括进入大都市地区/学术机构的机会有限以及住院医师培训项目较少。未来的计划和政策应致力于在美国各地实现眼科医生的均匀分布，并改善眼部护理的可及性。
