12261 Association Of Geographic And Demographic Factors With Receipt Of Endocrinology Care Among Adults With T2D And ASCVD Before And After Telemedicine Uptake
Authors: Zupa Margaret , Bauer Jessica , Rothenberger Scott , Zheng Yihao , Johnson Amber , Kinnee Ellen , Rosland Ann-Marie 
Published: October 2024

Disclosure: M. Zupa: None. J. Bauer: None. S. Rothenberger: None. Y. Zheng: None. A. Johnson: None. E. Kinnee: None. A. Rosland: None.

Care from endocrinologists has been linked to improved care quality and uptake of novel treatments which may improve outcomes for adults with T2D and ASCVD, who are at high risk for adverse health outcomes. However, transportation, geographic, and other barriers may impact access to specialty care for under-resourced populations. We sought to evaluate the impact of patient-level geographic and sociodemographic factors on receipt of endocrinology care before and after widespread telemedicine uptake. We conducted a retrospective cohort study of adults with T2D and ASCVD in a large health system from 1/2018-6/2022. ZIP Code centroids were used to map patients to their home geographic area, and multivariable logistic regression models evaluated associations between sociodemographic and geographic predictors with receipt of endocrinology care. Analyses were stratified into pre- (1/1/2018-3/15/20) and post- (3/16/2020-6/30/2022) telemedicine periods. Mixed effects models tested for differences in associations between the pre- and post-telemedicine periods. The cohort included 9,546 patients, with mean age 68.5 (SD 10.0), 39% female, 89% white, 83% urban residents; 1,725 patients received endocrinology care. In the pre-telemedicine period, geographic factors associated with receipt of endocrinology care included distance to the nearest endocrinology clinic (aOR 0.74 (95% CI 0.64-0.84) per 10 miles) and neighborhood walkability (aOR 1.38 (1.00-1.91) per 10 point increase on 0-20 scale); sociodemographic factors included age (aOR 0.70 (0.66-0.75 per 10 years), male gender (aOR 0.81 (0.72-0.92), race (aOR 1.21 for Black vs white, aOR 2.55 for Asian vs white, p=0.003), social deprivation index (0.95 (0.91-0.99) per 10 point increase on 0-100 scale, with higher values indicating more local area deprivation), and comorbidity burden (aOR 1.27 (1.02-1.59) for Elixhauser score 14+ vs &lt;0, p&lt;0.001). In the post-telemedicine period, distance to endocrinology clinic (aOR 0.82 (0.73-0.93) per 10 miles), age (aOR 0.67 (0.63-0.71) per 10 years), male gender (aOR 0.83 (0.74-0.94)), and comorbid conditions (aOR 1.13 (0.90-1.43) for Elixhauser score 14+ vs &lt;0, p&lt;0.001) were associated with receipt of endocrinology care. In mixed models comparing pre- vs. post-telemedicine periods, travel distance to endocrinology clinic, race, and social deprivation index had weaker associations with receipt of endocrinology care in the post-telemedicine period compared to pre-telemedicine, while older age was more negatively associated with care receipt post-telemedicine. These findings indicate that both geographic and sociodemographic factors impact receipt of endocrinology care among high-risk adults with T2D and ASCVD. Widespread availability of telemedicine may be associated with more equitable access to endocrinology care for some under-resourced populations.

Presentation: 6/3/2024