ABSTRACT

Purpose

To analyze differences between rates of complex and routine cataract surgery based on demographics and social determinants of health (SDOH) at the community level.

Methods

Data from adults ages 18 to 84 relevant to cataract surgery billing codes were extracted from the 2017 Florida Ambulatory Surgery dataset from the Agency for Healthcare Research and Quality merged with SDOH measures from the American Community Survey. A multivariable logistic regression model was used to determine associations between complex cataract surgery and SDOH according to patient ZIP code. Outcomes were reported as odds ratios (OR) with 95% confidence intervals (CI).

Results

A total of 171,754 and 11,340 patients received routine and complex cataract surgeries, respectively; females received the majority of routine surgeries (58.87%); most common age group (79.11%) was from 65 to 84 years. Male (odds ratio [OR] 2.034; p < 0.0001) and black patients (OR 1.998; p < 0.0001) more likely received complex surgery. Compared to Medicare patients, patients insured with Medicaid (OR 2.058; p < 0.0001), private insurance (OR 1.057; p = 0.0182), or self-pay (OR 1.570; p < 0.0001) were more likely to receive a complex surgery. ZIP codes with higher adult poverty (OR 2.614; p < 0.001) were more likely complex surgery patients, whereas those with higher rates of high school attendance (OR 0.487; p = 0.0193) and home occupancy (OR 0.704; p = 0.0047) were less likely to be complex.

Conclusions

Selected patient- and community-level factors including being male, Black, Asian, Hispanic, non-Medicare, or within lower education, higher poverty ZIP codes were associated with a higher likelihood of receiving complex cataract surgery.

中文翻译：

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佛罗里达州复杂性白内障手术与健康的社会决定因素之间的关联

摘要

目的

根据社区层面的人口统计和健康的社会决定因素 (SDOH)，分析复杂和常规白内障手术率之间的差异。

方法

与白内障手术计费代码相关的 18 至 84 岁成年人的数据是从医疗保健研究和质量机构的 2017 年佛罗里达门诊手术数据集中提取的，该数据集与美国社区调查的 SDOH 措施相结合。根据患者邮政编码，使用多变量逻辑回归模型确定复杂白内障手术与 SDOH 之间的关联。结果报告为具有 95% 置信区间 (CI) 的优势比 (OR)。

结果

共有 171,754 和 11,340 名患者分别接受了常规和复杂的白内障手术；女性接受了大部分常规手术（58.87%）；最常见的年龄组（79.11%）为 65 至 84 岁。男性（优势比 [OR] 2.034；p < 0.0001）和黑人患者（OR 1.998；p < 0.0001）更有可能接受复杂的手术。与 Medicare 患者相比，使用 Medicaid（OR 2.058；p < 0.0001）、私人保险（OR 1.057；p = 0.0182）或自费（OR 1.570；p < 0.0001）投保的患者更有可能接受复杂的手术。成人贫困率较高的邮政编码（OR 2.614；p< 0.001）更可能是复杂手术患者，而高中出勤率较高（OR 0.487；p = 0.0193）和家庭入住率（OR 0.704；p = 0.0047）的患者不太可能是复杂的。

结论

选定的患者和社区层面的因素，包括男性、黑人、亚裔、西班牙裔、非医疗保险或受教育程度较低、贫困程度较高的邮政编码与接受复杂白内障手术的可能性较高相关。