Health Disparities in the Development, Persistence, and Progression of Uveitis and Ocular Inflammation in the United States

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PROJECT SUMMARY Uveitis is an important cause of visual morbidity, responsible for an estimated 10% of blindness in the United States with an annual associated cost of $242.6 million. Prior studies have sought to elucidate the incidence and prevalence of uveitis; however, these studies have been limited in scope by age subset, localized geography, referral practice setting, or specialized health systems environment. The primary objectives of this K23 career development proposal are: 1) to demonstrate the benefit of using multiple databases to characterize the epidemiology of uveitis across the U.S., elucidating disparities in risk factors for its development, persistence, and progression; and 2) to provide an academic uveitis and vitreoretinal surgeon with the training and mentored research experience necessary to conduct independent clinical research. Achieving these objectives will provide critical skills and experiences necessary to establish an independent research program focused on applying clinical informatics to improve the clinical care of patients with uveitis. The proposed K23 application will provide additional training in four vital areas: 1) epidemiology and mechanisms of chronic disease; 2) quantitative characterization of health economics and health disparities; 3) biostatistical methods for health services research; 4) validation and analysis of very large clinical databases. The proposed research will capitalize on the strengths of two unique databases containing large and diverse cohorts of patients, including health claims-based data from the Optum Clinformatics Data Mart and electronic medical record-derived data from the Los Angeles County Department of Health Services safety net healthcare system, to generate exploratory knowledge on health disparities in the epidemiology and treatment of ocular inflammatory diseases. After validating longitudinal samples of patients with uveitis, the prevalence of uveitis in diverse populations will be estimated, documenting race-ethnic and other disparities. Risk factors for the development of uveitis and its sequelae will be incorporated in developing and testing models to investigate to what degree risk factors might affect health disparities. The interaction between race and smoking status will be a particular factor of interest. Population-based treatment patterns and health care costs associated with non-infectious uveitis will be characterized. Socioeconomic disparities in the utilization of steroid-sparing immunomodulatory therapy will be explored. The results of the proposed research will provide the foundation for a future longitudinal study examining the benefit of targeted interventions in patients at higher risk of blindness from uveitis. The ultimate goal of my research is to develop risk-stratification and treatment protocols that guide the standardized care of patients with uveitis and decrease the incidence of ocular inflammatory disease and its associated ocular morbidity.