Understanding disparities in availability of paediatric eye care: US report

A recent report¹ found that the disparities in access to ophthalmologic care for paediatric patients have increased over the past 15 years and are associated with lower socioeconomic status, according to Hannah Walsh, BS, and colleagues. She is from the University of Miami Miller School of Medicine in Miami, Florida, USA.

The investigators underscored the importance of accurate, publicly available online databases to identify the nearest paediatric ophthalmologists.

They commented, “The geographic distribution of paediatric ophthalmological care has not been reported since 2007; understanding this distribution could shed light on potential avenues to increase access, which is a necessary first step in addressing the paediatric ophthalmological needs of underserved areas.”

Ms Walsh and associates conducted a cross-sectional study to analyse the geographic distribution of paediatric ophthalmologists relative to the US population demographic characteristics. They used public databases from the American Academy of Ophthalmology and American Association for Pediatric Ophthalmology and Strabismus to identify the locations of US paediatric ophthalmologists as of March 2022.

Locations and numbers of paediatric ophthalmologists

The analysis identified 1,056 paediatric ophthalmologists, most of whom were in the most highly populated states: California (11.0%), New York (9.2%), Florida (6.5%) and Texas (5.9%).

“A total of 2,828 of 3,142 counties (90.0%) and 4 of 50 states (8.0%) had no paediatric ophthalmologists. In 314 counties (10.0%) with 1 or more paediatric ophthalmologists, the mean number of paediatric ophthalmologists per million persons was 7.7 (range, 0.4-185.5),” the investigators reported.

Household income was a factor, in that the counties with 1 or more paediatric ophthalmologists had a higher median household income compared with counties with 0 paediatric ophthalmologists ($70,230.59 vs $53,263.62, respectively), a difference that reached significance (P < 0.001).

Other factors identified were the proportions of families in each county without internet access (8.0% vs 4.7%, P < 0.001), patients younger than 19 years without health insurance (5.7% vs 4.1%, P < 0.001), and households without vehicle access (2.1% vs 1.8%) (P = 0.001) in counties with no compared with counties with 1 or more paediatric ophthalmologists.

The authors emphasised that disparities in geographic access to paediatric ophthalmologists persisted in 2022, and the range of practitioner to million persons has increased since 2007. Disparities in practitioner distribution were associated with lower socioeconomic status. Accurate publicly available information on the locations of paediatric ophthalmologists is warranted to increase access to care.

Reference

1. Walsh HK, Parrish A, Lucko L, et al. Access to pediatric ophthalmological care by geographic distribution and US population demographic characteristics in 2022. JAMA Ophthalmol. Published online January 26, 2023. doi:10.1001/jamaophthalmol.2022.6010