205-OR: Association of Geographic Factors with Use of Metabolic Disease Specialty Care among Adults with Type 2 Diabetes and ASCVD

Metabolic disease specialty care (endocrinology or cardiology) for T2D and ASCVD may improve quality of care and clinical outcomes. However, little is known about the associations of patient demographics and geographic, transportation, and technological barriers with use of specialty care.

In this retrospective cohort study, we linked geospatial and patient-level data for adults with T2D and ASCVD who had ongoing primary care in a large health system from 1/2018 to 6/2022. Patients were mapped to their residential ZIP Code centroids. Multivariate logistic regression assessed associations between baseline community predictors (public transit access, walkability, cellular data access) which were converted to within-cohort percentile rank, and patient predictors (distance from specialty clinic, demographics) with any specialty care visit.

Our cohort included 9,546 adults: 89% white, 83% urban residents. Greater neighborhood walkability was associated with increased specialty care use (AOR = 1.08, 95% CI (1.05-1.11) per 10^th percentile increase, p<0.001), while higher public transit stop density was associated with decreased use (AOR = 0.84 (0.72 - 0.98) 4^th vs 1^st quartile, p<0.001). Increased access to cellular data was associated with increased use (AOR=1.06 (1.03-1.09) per 10^th percentile, p<0.001). Distance to nearest clinic of either specialty was not significantly associated with overall care use (endocrinology AOR=0.986 (0.97 - 1.01) per 10 miles; cardiology AOR=1.01 (0.99-1.03)). Age (AOR 0.87 (0.84-0.91) per 10 years, p<0.001), race (AOR 0.78 (0.66-0.91) for Black vs white, p<0.001), and local area deprivation (AOR 0.94 (0.90-0.97) per 10^th percentile, p<0.001) were associated with less specialty care use.

Community and patient factors are independently associated with use of specialty care for adults with T2D and ASCVD. Differential utilization of specialty care may contribute to disparities in health outcomes for under-resourced populations.