Geographical barriers to surgical treatment for cataract among California Medicare beneficiaries.

PURPOSE: To examine geographic factors associated with the likelihood of receiving cataract surgery.

SETTING

Administrative claims data from 2017 California Medicare Database.

DESIGN

Cross-sectional.

METHODS

Beneficiaries were included if they were 65 years or older, had a valid postal code, active coverage with Medicare parts A and B, and cataract diagnosis defined by International Classification of Diseases, 10th Revision, Clinic Modification codes. Cataract surgery was defined using billing codes. The association between rural residence and distance and time traveled for cataract surgery was assessed using linear regression models. The odds of receiving cataract surgery were estimated using logistic regression models.

RESULTS

Among 445 164 beneficiaries with cataract, 127 314 (28.6%) reported rural residency. Rural residence was associated with increased travel time and distance for cataract surgery (+0.16 hours [95% CI 0.15-0.17]; +9.7 miles [95% CI 9.3-10.2]). For every additional 100 miles traveled, odds of cataract surgery decreased by 14% (adjusted odds ratio [aOR] 0.86, 95% CI 0.84-0.87). Stratified analysis demonstrated that Black beneficiaries had the greatest reduced odds of cataract surgery per each 100 additional miles traveled (aOR 0.38, 95% CI 0.31-0.45), followed by Hispanic/Latino beneficiaries (aOR 0.67, 95% CI 0.63-0.72).

CONCLUSIONS

Beneficiaries living in rural California had increased travel distance and time for cataract surgery. Black beneficiaries had the strongest association between increased travel distance and decreased odds of cataract surgery. These findings suggest possible disparities in surgical treatment for cataract among rural populations. Further studies are needed to better understand and address geographic disparities to eyecare.