Public Health and Primary CareORIGINAL ARTICLE
Abstract
Context: Shortages in medical subspecialty care, particularly endocrinology, present a growing challenge in the United States. In Ohio, structural inequities in the rural and Appalachian regions, including fewer healthcare providers, limited facilities, and barriers to transportation and broadband connectivity, contribute to delayed diabetes diagnoses, increased complications, and a higher mortality rate.
Objectives: This study aimed to examine the distribution of endocrinology subspecialists in Ohio and the corresponding prevalence of diabetes.
Methods: This cross-sectional study utilized public data gathered in 2022 from the Centers for Medicare & Medicaid Services (CMS) and the United States Diabetes Surveillance System (USDSS) to compare the mean prevalence and incidence of diabetes, the mean costs, and the Prevention Quality Indicator (PQI) scores for both short-term and long-term diabetes complications by Appalachian and non-Appalachian counties in Ohio.
Results: Of the 263 endocrinologists analyzed in this study, 21 (7.9 %) practiced in counties classified as Appalachian and 242 (92.1 %) practiced in counties classified as non-Appalachian (p<0.001). Moreover, only 9 of 32 (28.1 %) Appalachian counties had at least one practicing endocrinologist compared with 26 (46.4 %) of the non-Appalachian counties (p<0.1). The mean prevalence of diabetes was also significantly higher in Appalachian counties than in non-Appalachian counties (12.3±0.6 % vs. 11.2±0.9 %; p<0.01). In contrast, no statistically significant differences were observed in diabetes-related costs (p=0.4), short-term complications (p=0.2), or long-term complications (p=0.7) between Appalachian and non-Appalachian counties. The regression models found that although a higher density of endocrinologists per 100,000 persons was negatively associated with diabetes prevalence and incidence, none of these relationships reached statistical significance, with diabetes prevalence being the strongest predictor of endocrinologist concentration (Akaike Information Criterion [AIC]=258).
Conclusions: This study revealed a dual disparity in Appalachian Ohio, where these counties not only had fewer endocrinologists, but also had a higher prevalence and incidence of diabetes compared to non-Appalachian counties. Targeted strategies are needed to address this critical gap in subspecialty care in these Appalachian communities.