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Cited by 4Retinal Diseases and TreatmentsHealth Promotion and Cardiovascular PreventionOphthalmology and Visual Impairment Studies

Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening

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Lock, Loren J, Channa, Roomasa, Brennan, Meghan B, Cao, Ying, Liu, Yao·2022·BMJ Open Diabetes Research & Care
DOI 10.1136/bmjdrc-2022-003174PMC PMC9756146
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Abstract

Introduction: Rural versus urban disparities have been observed in diabetic eye screening, but whether the level of disadvantage in rural versus urban areas is related to these disparities is unclear. Our goal was to determine the role of level of disadvantage in explaining the effect of health systems on rural and urban disparities in diabetic eye screening. Research design and methods: This is a retrospective cohort study using an all-payer, state-wide claims database covering over 75% of Wisconsin residents. We included adults with diabetes (18–75 years old) who had claims billed throughout the baseline (2012–2013) and measurement (2013–2014) years. We performed multivariable regressions to assess factors associated with receipt of diabetic eye screening. The primary exposure was the primary care clinic’s combined level of rurality and disadvantage. We adjusted for the health system as well as patient-level variables related to demographics and comorbidities. Health system was defined as an associated group of physicians and/or clinics. Results: A total of 118 707 adults with diabetes from 698 primary care clinics in 143 health systems met the inclusion criteria. Patients from urban underserved clinics were less likely to receive screening than those from rural underserved clinics before adjusting for health system in the model. After adjusting for health system fixed effects, however, the directionality of the relationship between clinic rurality and screening reversed: patients from urban underserved clinics were more likely to receive screening than those from rural underserved clinics. Similar findings were observed for both Medicare and non-Medicare subgroups. Conclusions: The effect of health system on receipt of diabetic eye screening in rural versus urban areas is most pronounced in underserved areas. Health systems, particularly those providing care to urban underserved populations, have an opportunity to increase screening rates by leveraging health system-level interventions to support patients in overcoming barriers from social determinants of health.

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  • The baseline data in this study confirmed racial, ethnic, and socioeconomic gap closure disparities, similar to other studies demonstrating the wide range of disparities associated with social determinants of health in diabetic retinopathy screening.

    “The baseline data in this study confirmed these racial, ethnic, and socioeconomic gap closure disparities, similar to other studies demonstrating the wide range of disparities associated with social determinants of health in diabetic retinopathy screening9,41.”

    From Autonomous artificial intelligence increases screening and follow-up for diabetic retinopathy in youth: the ACCESS randomized control trial (2024) · cites this paper as [41]

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Cited by

Sorted by citations

Authors
Lock, L. J., Channa, R., Brennan, M. B., Cao, Y., & Liu, Y.
Affiliations
University of Wisconsin–Madison (US)
Corresponding author
Liu, Yao
ORCID
Venue
BMJ Open Diabetes Research & Care
Publisher
BMJ
Published
2022-12
Volume
10
Issue
6
Pages
e003174
ISSN
2052-4897 (ISSN-L)
DOI
10.1136/bmjdrc-2022-003174
PMC
PMC9756146
OpenAlex
W4311417418
Cited by
4
References
4
Citations by year
2026: 1 · 2025: 1 · 2024: 2
FWCI
0.67
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open Diabetes Research & Care (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • NIH/NEI (K23 EY026518, K23 EY030911-02)
  • Agency for Healthcare Research and Quality (K08 HS026279)
  • Research to Prevent Blindness (Not applicable)
  • NIH NIDDK (1R01 DK132569-01)
Topics
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Medicine › Epidemiology › Ophthalmology and Visual Impairment Studies
Keywords
diabetic retinopathy screening, diabetic retinopathy, rurality, socioeconomic deprivation, urban-rural differences, underserved populations, primary health centers, social determinants of health, Medicare, access to diabetes care
MeSH terms
Adolescent, Adult, Aged, Diabetes Mellitus, Medicare, Humans, Middle Aged, Retrospective Studies, Rural Population, United States, Urban Population, Young Adult

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