Socioeconomic Disparities Associated with Access to Oculofacial Plastic Surgeons: A Cross-Sectional Analysis of US County Demographics

Abstract

To compare population demographics with the geographic distribution of oculofacial plastic surgeons (OPS) in the United States (US). A cross-sectional study design was employed to investigate demographic differences between counties with one or more OPS and counties with zero OPS. The number of OPS were identified in each US County using online public databases - American Society of Ophthalmic Plastic and Reconstructive Surgeons; American Academy of Ophthalmology. Counties were categorized into two groups: one or more OPS and zero OPS. Demographic characteristics at the county level were obtained from the 2021 US Census Bureau Population Estimates and the American Community Survey. Cost of living was collected from the 2022 Economic Policy Institute Family Budget Calculator. Socioeconomic demographics of the US population as related to geographic OPS distribution. A total of 1238 OPS were identified. States with the most OPS per million were Hawaii (6.2), D.C. (6.0), Connecticut (5.8), Utah (5.1), and Maryland (5.0). Among 3143 counties, 2725 (86.7%) had zero OPS and 418 (13.3%) had one or more OPS. Counties with one or more OPS had a higher median (SD) household income versus counties with zero OPS ($72,969 [$19,724] vs. ($56,361 [$13,857]; difference $16,608; 95% CI, $14,489 to $18,727; P < 0.001). The annual cost of living per person (SD) was higher in counties with one or more OPS versus counties with zero OPS ($39,238 [$6,992] vs. $36,227 [$3,516]; difference $3,011; 95% CI $2,328 to $3,694; P < 0.001). Counties with zero OPS versus counties with one or more OPS had higher proportions of persons with only Medicaid (15.5% vs. 13.7%; difference 1.8%; 95% CI, 1.2% to 2.4%; P < 0.001), no health insurance (9.9% vs. 8.0%; difference 1.9%; 95% CI, 1.4% to 2.3%; P < 0.001), no household internet access (17.0% vs. 9.3%; difference 7.7%; 95% CI, 7.2% to 8.2%; P < 0.001), and higher proportions of persons 65 years or older (20.0% vs. 16.6%; difference 3.4%; 95% CI, 2.9% to 3.8%; P < 0.001). This cross-sectional analysis of all US counties revealed socioeconomic disparities associated with access to OPS.