2015 APHA Annual Meeting & Expo

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Recorded Annual Meeting Presentations (RAMP) are now available for purchase.
Only $90 for presenters, $140 for registered attendees and $200 for non-attendees.

Online Program

326216
Diagnosis of strabismus and spatial access to eye and pediatric care services among children in Michigan Medicaid


Monday, November 2, 2015 : 1:10 p.m. - 1:30 p.m.

Rebecca Anthopolos, MA, School of Natural Resources and Environment, University of Michigan, Ann Arbor, MI
Joshua Tootoo, MS, GISP, Children's Environmental Health Initiative, University of Michigan, Ann Arbor, MI
Joshua Stein, MD, MS, Department of Ophthalmology & Visual Science, University of Michigan, Ann Arbor, MI
Chris Andrews, PhD, Department of Ophthalmology & Visual Science, University of Michigan, Ann Arbor, MI
Paul Lee, MD, JD, Department of Ophthalmology & Visual Science, University of Michigan, Ann Arbor, MI
Marie Lynn Miranda, PhD, School of Natural Resources & Environment, University of Michigan, Ann Arbor, MI
Audio (mp3) recording Recorded Presentation (mp4)
Objectives. Previous research has suggested that the receipt of eye care services among Medicaid children was associated with neighborhood availability of eye care providers. We hypothesized that 1) the odds of strabismus diagnosis increased with higher access to eye and pediatric care; 2) urbanicity acted as an effect modifier; and 3) neighborhood socioeconomic status (SES) accounted for urban-rural differences.

Methods. We obtained 2009 Medicaid Analytic Extract health claims for all children age ≤10 years living in Michigan (N=498,087). Based on the National Provider Index database, we developed an index of spatial access to eye and pediatric care operationalized at each child’s residential Zip Code Tabulation Area (ZCTA). Race-stratified multilevel logistic random intercept models were fit to investigate the relationship of child-level strabismus diagnosis with ZCTA-level measures of spatial access to eye and pediatric care, urbanicity, and SES, adjusting for child sex and age.

Results. The prevalence of strabismus diagnosis was 1.7, 0.8, and 1.0 percent among Whites, Blacks, and Hispanics, respectively. An interquartile difference in care access was associated with 1.04 times the odds of strabismus diagnosis among Whites (95% CI: 1.001, 1.08), but not among Blacks and Hispanics. Among Blacks, the odds of diagnosis were 1.15 times higher per interquartile difference in median household income (95% CI: 1.07, 1.24). Urban-rural status was not associated with strabismus diagnosis.

Conclusions. Future research is needed to understand racial differences in the association between strabismus diagnosis and spatial access to eye and pediatric care.

Learning Areas:

Provision of health care to the public
Public health or related research

Learning Objectives:
Evaluate gravity model based approach to quantifying spatial accessibility for eye and pediatric care services. Discuss the differential association between eye and pediatric care access and strabismus access by race group. Identify risk factors that differentially relate to strabismus diagnosis by races.

Keyword(s): Vision Care, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an ophthalmologist and health services researcher with an advanced degree in evaluative clinical sciences. A key area of research interest of mine is assessing access to care, utilization, and outcomes for patients with ophthalmological conditions.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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