Introduction: Effective treatment of eye diseases largely depends on an integrated, tiered system of ophthalmic care in which specialized tertiary centers play a key role. Primary and secondary healthcare facilities differ from tertiary institutions in their material and technical resources and professional staffing, and severe ocular conditions may require treatment at a specialized tertiary center. The prevalence of eye diseases and the clinical profile of patients receiving tertiary care vary across regions and countries, and pediatric ophthalmic care at this level deserves particular attention. Consequently, the volume and spectrum of demand for ophthalmic services may differ substantially between rural and urban populations.
Purpose: To assess the rate and diagnostic structure of inpatient admissions for tertiary ophthalmic care among rural residents, residents of district centers (small towns), and residents of cities of republican subordination in Azerbaijan.
Materials and Methods: This retrospective study was conducted at the National Center of Ophthalmology named after Academician Zarifa Aliyeva. Tertiary ophthalmic care was analyzed using inpatient databases for 2017–2021. Primary diagnoses (reasons for admission) were coded according to ICD-10. Patients were divided by place of residence into three groups: rural residents, residents of district centers (small towns), and residents of cities of republican subordination (population >100,000). The mean annual inpatient admission rate per 100,000 population was calculated for each group and is presented as mean ± standard error (SE). Differences between rural and urban populations were assessed using Pearson’s chi-square test; statistical significance was set at p ≤ 0.05.
Results: The overall rate of tertiary inpatient admissions was lower among residents of cities of republican subordination (84.0 ± 3.26 per 100,000 population). By contrast, it was significantly higher (p = 0.001), by approximately 1.4–1.6 times, among rural residents (120.9 ± 1.69) and district center residents (131.7 ± 2.74). Admission rates in district center and rural residents also differed significantly (p = 0.01).
Cataract was the leading cause of admission in all groups. Its rate was lowest among residents of cities of republican subordination (31.6 ± 2.00), nearly twice as high among district center residents (59.4 ± 1.84), and intermediate among rural residents (47.7 ± 1.06) (p = 0.01).
Rhegmatogenous retinal detachment, the second most common cause of admission, varied within a narrow range and showed no significant difference: 7.7 ± 0.66 (district centers), 9.8 ± 1.11 (cities of republican subordination), and 10.5 ± 0.49 (rural areas) (p = 0.098). For the remaining diagnoses, rates are given in the same order (district centers; cities of republican subordination; rural areas). No significant differences (p ≥ 0.105) were found for chalazion (0.9 ± 0.33; 1.6 ± 0.30; 1.4 ± 0.13), lacrimal duct stenosis and insufficiency (0.6 ± 0.28; 1.0 ± 0.24; 0.8 ± 0.14), enophthalmos (0.3 ± 0.17; 0.8 ± 0.21; 0.8 ± 0.13), pterygium (1.7 ± 0.45; 3.1 ± 0.42; 2.3 ± 0.23), uveal diseases (4.6 ± 0.76; 4.7 ± 0.51; 5.3 ± 0.35), macular and posterior pole degeneration (1.5 ± 0.44; 3.0 ± 0.41; 2.1 ± 0.22), disorders of the globe (1.4 ± 0.42; 1.6 ± 0.30; 1.5 ± 0.19), strabismus (3.2 ± 0.63; 3.2 ± 0.42; 3.4 ± 0.26), or refractive errors (1.4 ± 0.42; 2.6 ± 0.38; 2.8 ± 0.26).
Significant differences (p ≤ 0.01) were found for keratitis (3.4 ± 0.66; 7.3 ± 0.64; 6.2 ± 0.38), retinoschisis and retinal cysts (4.5 ± 0.75; 7.4 ± 0.65; 6.8 ± 0.40), retinal vascular occlusion (4.3 ± 0.77; 7.2 ± 0.64; 6.9 ± 0.40), diabetic retinopathy (2.4 ± 0.55; 0.9 ± 0.22; 3.8 ± 0.30), glaucoma (3.2 ± 0.63; 3.6 ± 0.45; 6.0 ± 0.38), and ocular trauma (5.5 ± 0.83; 8.7 ± 0.70; 7.5 ± 0.42).
Conclusion: The demand for tertiary inpatient ophthalmic care is lower among residents of large cities of republican subordination and markedly higher among rural and district center residents. The diagnostic structure of admissions was broadly similar across the groups, with cataract, rhegmatogenous retinal detachment, ocular trauma, uveal diseases, retinoschisis and retinal cysts, and retinal vascular occlusion predominating.
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