Abstract
Aims: This study explored rural disparities in eyecare utilization among adult patients with diabetes with mild/moderate and severe diabetic retinopathy in the rural state of West Virginia, United States.
Methods: Demographic characteristics, clinical and vision/eye care utilization data were collected from electronic health records at West Virginia University Eye Institute and affiliated teleophthalmology clinics. A manual review identified patients who received eye care services between October 2015 and March 2024 (n=11,633). Patient’s residence was categorized using the rural-urban commuting area codes. Unadjusted and adjusted logistic regression of eye-care visits by diagnosis (diabetes, mild/moderate diabetic retinopathy, severe diabetic retinopathy and rural residence were conducted adjusting for sociodemographic, behavioral, clinical factors and comorbidities.
Results: The mean age and HbA1c was 59.7 ± 14.2 years and 7.8 ± 1.9%, respectively. In the adjusted multivariable logistic regression controlling for established risk factors, rural residence was associated with higher visits (OR = 1.47, 95% confidence interval [CI] = 1.04 to 2.08), P<.001. Higher visits were also noted among rural (vs. urban) patients with severe DR complications (aOR=1.70; 95% CI = 1.48 to 1.96) and mild/moderate DR (aOR= 1.34; 95% CI = 1.18 to 1.52), P<.001.
Conclusions: A clear rural disadvantage was noted in eyecare utilization among rural patients with severe diabetic retinopathy. Teleophthalmology may provide opportunities for timely screening and treatment to reduce preventable blindness.