Geographic and Sociodemographic Factors and Receipt of Metabolic Disease Specialty Care
Authors' conclusion
In this cohort study of adults with type 2 diabetes and atherosclerotic cardiovascular disease, geographic and sociodemographic factors were associated with receipt of endocrinology and cardiology care. Widespread availability of telemedicine may enhance equitable access to endocrinology care for patients facing geographic barriers, but disparities in use of specialty care by age and race persisted in the posttelemedicine period.
Study context
- Population
- Adults with T2D and atherosclerotic CVD receiving primary care, January 2018–June 2022, large health system in Pennsylvania; mean age 68.5 years, 61% male, 83% urban
- Participants
- 9,546 adults
- Exposure
- Geographic and sociodemographic factors; pre- vs posttelemedicine period
- Outcome
- ≥1 outpatient visit with endocrinology or cardiology
- Follow-up
- Pretelemedicine (Jan 1, 2018–Mar 15, 2020) and posttelemedicine (Mar 16, 2020–Jun 30, 2022) periods
Methodological detailslarge health system spanning urban and rural counties, geospatial analysis, multivariable logistic regression, mixed-effects models
- Large health system spanning urban and rural counties
- Geospatial analysis
- Multivariable logistic regression
- Mixed-effects models
Main finding
As reported in the abstract
pretelemedicine period
- Received endocrinology care
- 1747
- Received cardiology care
- 5578
- Distance to endocrinology clinic, endocrinology care, aOR per 10 miles
- 0.74 (95% CI 0.64-0.84)
- Older age, endocrinology care, aOR per 10 years
- 0.70 (95% CI 0.66-0.75)
- Black vs White patients, cardiology care, aOR
- 0.71 (95% CI 0.60-0.82)
Observational data: associations, not effects.
Further findings
Posttelemedicine period
- aOR for distance to clinic increased, aOR for older age decreased
- Lower cardiology care in Black vs White patients persisted
Original publication
Geographic and Sociodemographic Factors and Receipt of Metabolic Disease Specialty Care. JAMA Netw Open. Published 1 May 2025. doi:10.
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