Mapping diabetic eye exam non-adherence across urban-rural communities: A GIS-based regional analysis of socioeconomic disadvantage in the Rochester, NY Metropolitan Statistical Area.

AIMS: Diabetic eye examinations prevent vision loss, yet adherence varies across communities. We examined ZIP Code Tabulation Area (ZCTA)-level socioeconomic and spatial determinants of diabetic eye exam non-adherence across the Rochester, NY Metropolitan Statistical Area (MSA).

METHODS

We conducted a retrospective cross-sectional GIS analysis of adults with diabetes in a university-affiliated primary care network. Healthcare Effectiveness Data and Information Set (HEDIS)-defined eye exam adherence was aggregated by patient address ZIP code to ZCTAs. Predictors were poverty rate, Medicaid enrollment, and rurality. Analyses included community-type comparisons, ordinary least-squares regression, stratified regression, and bivariate choropleth mapping.

RESULTS

Mean non-adherence was 33.2%. Mean rates were similar in urban, suburban, and rural ZCTAs (33.2%, 31.9%, and 33.7%; F = 0.23, p = 0.795), although rural ZCTAs showed greater variability. Poverty was associated with non-adherence in univariate analysis (β = 0.304, p < 0.001) and after adjustment for rurality and Medicaid enrollment (β = 0.342, p < 0.001). Medicaid enrollment was significant only in univariate analysis. Rurality was not associated overall. GIS maps showed overlap between high non-adherence, poverty, and Medicaid in urban core ZCTAs.

CONCLUSIONS

GIS mapping can help health systems identify priority ZCTAs for teleophthalmology, mobile eye care, patient navigation, referral support, and targeted primary care outreach.