Racial and Socioeconomic Differences in Eye Care Utilization among Medicare Beneficiaries with Glaucoma.
Racial and Socioeconomic Differences in Eye Care Utilization among Medicare Beneficiaries with Glaucoma.
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DOI：
10.1016/j.ophtha.2021.09.022
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发表时间：
2022-04
期刊：
影响因子：
13.7
通讯作者：
Zebardast N
中科院分区：
文献类型：
--
作者：
Halawa OA;Kolli A;Oh G;Mitchell WG;Glynn RJ;Kim DH;Friedman DS;Zebardast N
评估不同种族和社会经济地位（SES）青光眼患者眼保健使用的差异。回顾性队列研究。在2014年1月1日至2014年7月1日期间连续入组A/B部分的65岁以上Medicare受益人的代表性5%样本，在此期间至少有一个青光眼诊断代码，并且在2014年1月1日之前在慢性疾病仓库中诊断为青光眼。在我们的队列中定义了以下人种/种族类别：非西班牙裔白色、黑人/非裔美国人、西班牙裔和亚洲/太平洋岛民。低社会经济地位被定义为具有两个或两个以上基于登记的低收入指标（医疗保险/医疗补助的双重资格，D部分有限的收入补贴，以及A部分和B部分国家买入的资格）。进行负二项回归分析，以比较不同种族组（按低和非低SES分层）的眼科护理利用率相对比率（RR）。从2014年7月1日至2016年12月31日测量：眼科检查和眼科护理相关门诊访视;眼科护理相关住院和艾德就诊;眼科护理相关疗养院和家访就诊;视野和视网膜神经纤维光学相干断层扫描检查;青光眼激光和手术。在78，526名青光眼患者中，平均年龄为79.1岁（SD 7.9岁），60.9%为女性，78.4%为非西班牙裔白色人，13.8%符合低SES的入组标准。与白色受益人相比，黑人的门诊次数（率比[RR] 0.92，95% CI 0.90-0.93）、VF检查次数（RR 0.92，95% CI 0.90-0.94）较少，但住院/艾德就诊次数（RR 2.42，95% CI 1.55-3.78）和手术次数（RR 1.14，95% CI 1.03-1.7）较多。与非西班牙裔白人相比，西班牙裔白人的门诊就诊（RR 0.97，95% CI 0.95-0.98）和RNFL OCT检查（RR 0.89，95% CI 0.86-0.93）较少，但住院/艾德就诊（RR 2.32，95% CI 1.18-4.57）和复发（RR 1.25，95% CI 1.11-1.42）较多。在非低SES组中，黑人与白色的差异在门诊访视（RR 0.93，95% CI 0.92-0.95）、VF（RR 0.96，95% CI 0.94-0.98）、RNFL OCT（RR 0.81，95% CI 0.78-0.83）和住院/艾德就诊（RR 2.57，95% CI 1.55-4.26）中持续存在。黑人和西班牙裔青光眼患者的眼部护理利用率存在差异。这些差异持续黑人分层后，社会经济地位，这表明系统性的种族主义可能是一个独立的驱动程序，在这个人口。
Evaluate differences in eyecare utilization among glaucoma patients by race and socioeconomic status (SES). Retrospective cohort study. Representative 5% sample of Medicare beneficiaries >65 years with continuous part A/B enrollment between 1/1/2014 and 7/1/2014, at least one diagnosis code for glaucoma within that period, and a glaucoma diagnosis in the Chronic Conditions Warehouse before 1/1/2014. The following race/ethnicity categories were defined in our cohort: Non-Hispanic White, Black/African American, Hispanic and Asian/Pacific Islander. Low SES was defined as having two or more enrollment-based low-income indicators (dual eligibility for Medicare/Medicaid, Part D limited income subsidies, and eligibility for Part A and B State buy-in). Negative binomial regression analyses were carried out to compare relative rate ratios (RR) of eye care utilization among racial groups, stratified by low- and non-low-SES. Measured from 7/1/2014–12/31/2016: eye examinations and eye care-related office visits; eye care-related inpatient and ED encounters; eye care-related nursing home and home-visit encounters; visual field and retinal nerve fiber optical coherence tomography tests; glaucoma lasers and surgeries. Among 78,526 participants with glaucoma, mean age was 79.1 years (SD 7.9 years), 60.9% were female, 78.4% were non-Hispanic White and 13.8% met enrollment-based criteria for low-SES. Compared to White beneficiaries, Blacks had lower counts of outpatient visits (rate ratio [RR] 0.92, 95% CI 0.90–0.93), VF tests (RR 0.92, 95% CI 0.90–0.94), but more inpatient/ED encounters (RR 2.42, 95% CI 1.55–3.78), and surgeries (RR 1.14, 95% CI 1.03–1.7). Hispanics had fewer outpatient visits (RR 0.97, 95% CI 0.95–0.98) and RNFL OCT tests (RR 0.89, 95% CI 0.86–0.93), but more inpatient/ED encounters (RR 2.32, 95% CI 1.18–4.57) and SLT (RR 1.25, 95% CI 1.11–1.42) vs. non-Hispanic Whites. In the non-low-SES group, Black vs. White disparities persisted in outpatient visits (RR 0.93 95% CI 0.92–0.95), VF (RR 0.96 95% CI 0.94–0.98), RNFL OCT (RR 0.81, 95% CI 0.78–0.83) and inpatient/ED encounters (RR 2.57, 95% CI 1.55–4.26). Disparities were found in eye care utilization among Black and Hispanic glaucoma patients. These differences persisted among Blacks after stratification by SES, suggesting systemic racism may be an independent driver in this population.
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