Racial and Sociodemographic Disparities in the Detection of Narrow Angles before Detection of Primary Angle-Closure Glaucoma in the United States.
Racial and Sociodemographic Disparities in the Detection of Narrow Angles before Detection of Primary Angle-Closure Glaucoma in the United States.
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DOI：
10.1016/j.ogla.2022.01.001
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发表时间：
2022-07
影响因子：
2.9
通讯作者：
Xu, Benjamin
中科院分区：
文献类型：
--
作者：
Apolo, Galo;Bohner, Austin;Pardeshi, Anmol;Lung, Khristina;Toy, Brian;Wong, Brandon;Song, Brian;Camp, Andrew;Xu, Benjamin
评估既往诊断为和未诊断为解剖学窄角（ANA）的新诊断PACG病例的比例，并确定晚期检测（既往未诊断为ANA的PACG）的社会人口学风险因素。回顾性队列研究。从Optum Clinformatics® Data Mart数据库（2007-2019）中确定了102，617例PACG患者。新诊断的PACG符合以下标准：1）由眼科医生诊断，2）诊断前至少12个月可观察到，3）诊断前无治疗史，除非之前诊断为ANA。进行多变量logistic回归建模，以确定延迟检测的社会人口学风险因素。新诊断的PACG的比例，既往未诊断ANA和与晚期检测相关的社会人口学因素。有31，044名合格患者。超过70%的PACG是在没有先前ANA诊断的情况下检测到的，无论年龄、性别和种族如何。晚发现的几率明显高于（p<0.001）（OR=1.32，[1.25-1.40]），黑人（OR=1.25，[1.15-1.37]），以及年龄≥ 80岁的患者（OR=1.28，[1.11-1.47]）或居住在南方（OR=1.30，[1.22-1.40]）或太平洋（OR=1.27，[1.16-1.36]）地区。有房角镜检查和治疗记录或有24个月回顾期的PACG病例的结果相似。在美国，大多数新诊断为PACG的患者之前没有ANA的诊断。老年人、男性和黑人被发现的风险更高。需要提高医疗服务提供者的疾病意识，并提供更容易获得的工具来检测有PACG风险的患者。在美国，超过70%的PACG是新诊断的，以前没有诊断出解剖学狭窄的角度。老年人，男性，黑人和南部/太平洋地区的患者更容易受到晚期ANA检测的影响。
To assess the proportion of newly diagnosed cases of PACG with and without prior diagnosis of anatomical narrow angles (ANA) and identify sociodemographic risk factors for late detection (PACG without prior ANA diagnosis). Retrospective cohort study. 102,617 patients with PACG were identified from the Optum Clinformatics® Data Mart Database (2007-2019). Newly diagnosed PACG met the following criteria: 1) diagnosis by an ophthalmologist, 2) observable for at least 12 months prior to diagnosis, 3) no history of treatment before diagnosis unless preceded by a diagnosis of ANA. Multivariable logistic regression modeling was performed to identify sociodemographic risk factors for late detection. Proportion of newly diagnosed PACG without prior ANA diagnosis and sociodemographic factors associated with late detection. There were 31,044 eligible patients. Over 70% of PACG was detected without prior ANA diagnosis, regardless of age, sex, and race. Odds of late detection was significantly higher (p<0.001) among males (OR=1.32, [1.25-1.40]), Blacks (OR=1.25, [1.15-1.37]), and patients aged 80 years or older (OR=1.28, [1.11-1.47]), or living in Southern (OR=1.30, [1.22-1.40]) or Pacific (OR=1.27, [1.16-1.36]) regions. Findings were similar for cases of PACG with record of gonioscopy and treatment or with a 24-month lookback period. Most patients newly diagnosed with PACG in the United States do not have a prior diagnosis of ANA. The elderly, males, and Blacks are at higher risk of late detection. There exists a need for increased disease awareness among providers and more accessible tools to detect patients at risk for PACG. More than 70% of PACG in the United States is newly diagnosed without prior diagnosis of anatomical narrow angles. The elderly, males, Blacks, and patients in Southern/Pacific regions are more vulnerable to late ANA detection.
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