title: Impact of geographic density of eye care professionals on eye care among adults with diabetes.
abstract: OBJECTIVE
  To examine the impact of the geographic density of eye care professionals (ECPs) on the receipt of annual dilated eye examinations among adults in the United States with diabetes.
  
  
  METHODS
  Data from the 2006 Behavioral Risk Factor Surveillance System were linked to the 2007 Area Resource File to examine the association between the density of ECPs (ophthalmologists and optometrists) per 100,000 people and self-reports of having had a dilated eye examination in the last year. The sample included adults aged 18+ years with diabetes (N = 29,495). Multivariate logistic regression was conducted to estimate adjusted odds ratios of annual dilated eye examinations, while controlling for age, sex, marital status and education, and stratifying by health insurance.
  
  
  RESULTS
  Approximately 10% of respondents with diabetes lived in counties with no ECPs. Prevalence of being uninsured was 7.4% and 15.5% in those with and without dilated eye exams, respectively. After controlling for covariates and stratifying by health insurance, diabetic adults with health insurance cover residing in areas with no ECPs were less likely to report having had a dilated eye examination in the past year than those with 20 or more ECPs/100,000 people (odds ratio 0.72, 95% confidence interval 0.58-0.91).
  
  
  CONCLUSIONS
  Residence in a county with a low density of ECPs reduced the likelihood of receiving annual dilated eye examinations among insured adults with diabetes. Enhancing the ability of ECPs to reach and care for those in need might better protect vision in people with diabetes. More research is needed to determine the mix of services that produces the best patient outcome.
authors.affiliation: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3727, USA. CChou@cdc.gov
authors.forename: Chiu-Fang
authors.initials: CF
authors.lastname: Chou
authors.forename: Xinzhi
authors.initials: X
authors.lastname: Zhang
authors.forename: John E
authors.initials: JE
authors.lastname: Crews
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Barker
authors.forename: Paul P
authors.initials: PP
authors.lastname: Lee
authors.forename: Jinan B
authors.initials: JB
authors.lastname: Saaddine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003695:Delivery of Health Care; D003930:Diabetic Retinopathy / Q000517:prevention & control*; D005260:Female; D005843:Geography; D006295:Health Resources; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology; D010808:Physical Examination; D011159:Population Surveillance; D011320:Primary Health Care / Q000706:statistics & numerical data*; D000078329:Workforce; D055815:Young Adult