A Geodemographic Analysis of Time Travel to Uveitis Specialists in the United States
Krishna Mallem, BS
Krishna Mallem BS, 1,2, Meghan Berkenstock MD, 2
1. Drexel University College of Medicine
2. Division of Ocular Immunology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore MD
Purpose: Travel time to a patient’s medical provider represents a significant component of access to care. We performed a service coverage analysis using 2016-2020 American Census Bureau and American Community Survey Data to assess driving time to patients’ nearest American Uveitis Society (AUS) specialist, and compared demographic factors such as race, dependency status, poverty status, and healthcare status in order to observe significant differences between populations found within and outside service area coverage.
Methods: Addresses of fellowship trained uveitis specialists were collected from the AUS or the Ocular Immunology and Uveitis Foundation websites and geocoded using ArcGIS Pro 2.9. Service areas were defined as all locations within a 60-minute drive time from each specialist’s location. Demographic and population data for total population, racial groups, household poverty levels, population in dependent groups (younger than 18, older than 65), and health insurance status were overlaid. Data was aggregated for census tracts within and outside service areas and compared using chi square analysis.
Results: Of the total US population, 63.3% were found to be within service areas. Of these, 55.9% are Caucasian and 14.7% are African American, whereas 70% of people outside service areas are Caucasian and 10.1% are African American. Only 8.3% of people within service area coverage have no health insurance compared with 9.5% outside service areas (p<0.0001). In those insured within service area coverage, 36.2% have government-sponsored insurance versus 43.3% outside of coverage areas. Within coverage areas, 12.7% of households have a total income below the federal poverty level versus 15.1% of households outside service area coverage (p<0.0001). Within service area coverage, 37.4% of people are in a dependent age group compared with 40.4.% outside service area coverage (p <0.0001).
Conclusion: Our analysis shows a significant travel burden to the nearest uveitis specialist for a large proportion of Americans, and a relative saturation of uveitis specialists in metropolitan areas. This underlines the importance of increasing the number of fellowship-trained uveitis specialists in areas that fall outside of existing service coverage, especially rural areas, as patients there are more likely to live under the poverty line, be uninsured, or belong to a dependent age group.