Large Disparities in Receipt of Glaucoma Care between Enrollees in Medicaid and Those with Commercial Health Insurance
Large Disparities in Receipt of Glaucoma Care between Enrollees in Medicaid and Those with Commercial Health Insurance
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DOI：
10.1016/j.ophtha.2017.05.003
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发表时间：
2017-10-01
期刊：
影响因子：
13.7
通讯作者：
Stein, Joshua D.
中科院分区：
文献类型：
--
作者：
Elam, Angela R.;Andrews, Chris;Stein, Joshua D.
目的：为了确定患者拥有的健康保险类型和患者的种族/民族是否影响接受常见测试以监测开角型青光眼（OAG）。设计：回顾性纵向队列研究。参与者：2007年至2011年期间，共有21 766名年龄>= 40岁的新诊断OAG患者参加了Medicaid或大型美国管理式护理网络。方法：我们确定了新诊断的OAG患者在首次OAG诊断后的前15个月内接受视野（VF）检查、眼底照相（FP）、其他眼部成像（OOI）或不接受这些检查的比例。多变量逻辑回归用于评估健康保险类型和种族/民族影响青光眼检查几率的程度。主要结局指标：结果：18372名商业健康保险患者和3394名医疗补助接受者符合研究纳入标准。新诊断OAG的商业健康保险人员接受VF，FP和OOI的比例分别为63%，22%和54%，而医疗补助接受者的比例分别为35%，19%和30%。与那些有商业健康保险的人相比，医疗补助接受者在首次诊断后15个月内不接受任何青光眼检查的可能性高234%（OR = 3.34; 95%CI，3.07-3.63）。调整混杂因素后，与拥有商业健康保险的白人相比，参加医疗补助的OAG白人未接受青光眼检测的几率高出198%（OR = 2.98; 95%CI，2.66-3.33）。黑人与医疗保险表现出291%的高赔率（OR = 3.91; 95%CI，3.40-4.49）没有接受任何青光眼测试与黑人相比，商业healthinsurance.Conclusions：无论种族/民族，OAG的医疗补助受助人接受大大低于青光眼测试与商业健康保险的人。在所有种族/民族中观察到测试差异，但黑人最明显。这些发现特别令人不安，因为黑人比白人更有可能因OAG而失明，而且医疗补助计划中的黑人人数不成比例地多。需要努力提高医疗补助接受者，特别是少数民族的青光眼护理质量。(C)2017年美国眼科学会
Purpose: To determine whether the type of health insurance a patient possesses and a patient's race/ethnicity affect receipt of common tests to monitor open-angle glaucoma (OAG).Design: Retrospective longitudinal cohort study.Participants: A total of 21 766 persons aged >= 40 years with newly diagnosed OAG between 2007 and 2011 enrolled in Medicaid or a large United States managed care network.Methods: We determined the proportion of patients with newly diagnosed OAG who underwent visual field (VF) testing, fundus photography (FP), other ocular imaging (OOI), or none of these tests within the first 15 months after initial OAG diagnosis. Multivariable logistic regression was used to assess the extent by which health insurance type and race/ethnicity affected the odds of undergoing glaucoma testing. Main Outcome Measures: Odds ratios (OR) of undergoing VF testing, FP, OOI, or none of these tests in the 15 months after initial OAG diagnosis with 95% confidence intervals (CI).Results: A total of 18 372 persons with commercial health insurance and 3394 Medicaid recipients met the study inclusion criteria. The proportions of persons with commercial health insurance with newly diagnosed OAG who underwent VF, FP, and OOI were 63%, 22%, and 54%, respectively, whereas the proportions were 35%, 19%, and 30%, respectively, for Medicaid recipients. Compared with those with commercial health insurance, Medicaid recipients were 234% more likely to not receive any glaucoma testing in the 15 months after initial diagnosis (OR = 3.34; 95% CI, 3.07-3.63). After adjustment for confounders, whites with OAG enrolled in Medicaid had 198% higher odds of receiving no glaucoma testing compared with whites possessing commercial health insurance (OR = 2.98; 95% CI, 2.66-3.33). Blacks with Medicaid insurance demonstrated 291% higher odds (OR = 3.91; 95% CI, 3.40-4.49) of not receiving any glaucoma testing compared with blacks with commercial health insurance.Conclusions: Irrespective of race/ethnicity, Medicaid recipients with OAG are receiving substantially less glaucoma testing compared with persons with commercial health insurance. Disparities in testing are observed across all races/ethnicities but were most notable for blacks. These findings are particularly disconcerting because blacks are more likely than whites to go blind from OAG and there are disproportionately more blacks in Medicaid. Efforts are needed to improve the quality of glaucoma care for Medicaid recipients, especially racial minorities. (C) 2017 by the American Academy of Ophthalmology