Purpose

Evaluate differences in eye care utilization among patients with glaucoma by race and socioeconomic status (SES).

Design

Retrospective cohort study.

Participants

Representative 5% sample of Medicare beneficiaries aged > 65 years with continuous part A/B enrollment between January 1, 2014, and July 1, 2014, at least 1 diagnosis code for glaucoma within that period, and a glaucoma diagnosis in the Chronic Conditions Warehouse before January 1, 2014.

Methods

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 2 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 (RRs) of eye care utilization among racial groups stratified by low and non-low SES.

Main Outcome Measures

Measured from July 1, 2014, to December 31, 2016: eye examinations and eye care–related office visits; eye care–related inpatient and emergency department (ED) encounters; eye care–related nursing home and home-visit encounters; visual field and retinal nerve fiber OCT tests; glaucoma lasers and surgeries.

Results

Among 78 526 participants with glaucoma, mean age was 79.1 years (standard deviation, 7.9 years), 60.9% were female, 78.4% were non-Hispanic White, and 13.8% met enrollment-based criteria for low-SES. Compared with White beneficiaries, Blacks had lower counts of outpatient visits (RR, 0.92; 95% confidence interval [CI], 0.90–0.93), visual field (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, 1.03–1.27). Hispanics had fewer outpatient visits (RR, 0.97; 95% CI, 0.95–0.98) and retinal nerve fiber layer (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 selective laser trabeculoplasty (SLT) (RR, 1.25; 95% CI, 1.11–1.42) versus non-Hispanic Whites. In the non-low SES group, Black versus 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).

Conclusions

Disparities were found in eye care utilization among Black and Hispanic patients with glaucoma. These differences persisted among Blacks after stratification by SES, suggesting that systemic racism may be an independent driver in this population.

中文翻译：

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青光眼医疗保险受益人眼保健利用的种族和社会经济差异

目的

评估不同种族和社会经济地位 (SES) 的青光眼患者在眼科护理利用方面的差异。

设计

回顾性队列研究。

参加者

在 2014 年 1 月 1 日至 2014 年 7 月 1 日期间连续参加 A/B 部分且至少有 1 个青光眼诊断代码且在 Chronic Conditions Warehouse 中有青光眼诊断的年龄 > 65 岁且具有代表性的 5% Medicare 受益人样本2014 年 1 月 1 日之前。

方法

在我们的队列中定义了以下种族/民族类别：非西班牙裔白人、黑人/非裔美国人、西班牙裔和亚洲/太平洋岛民。低 SES 被定义为具有 2 个或更多基于入学率的低收入指标（医疗保险/医疗补助的双重资格、D 部分有限收入补贴以及 A 部分和 B 部分州买入的资格）。进行了负二项式回归分析，以比较按低 SES 和非低 SES 分层的种族群体眼保健利用率的相对比率 (RR)。

主要观察指标

2014 年 7 月 1 日至 2016 年 12 月 31 日：眼科检查和与眼科护理相关的门诊就诊；与眼科护理相关的住院和急诊科 (ED) 遭遇；与眼部护理相关的疗养院和家访；视野和视网膜神经纤维OCT检查；青光眼激光和手术。

结果

在 78 526 名青光眼参与者中，平均年龄为 79.1 岁（标准差为 7.9 岁），60.9% 为女性，78.4% 为非西班牙裔白人，13.8% 符合低 SES 入组标准。与白人受益人相比，黑人的门诊就诊次数（RR，0.92；95% 置信区间 [CI]，0.90–0.93）、视野 (VF) 测试（RR，0.92；95% CI，0.90–0.94）、但更多的是住院/急诊（RR，2.42；95% CI，1.55-3.78）和手术（RR，1.14；95% CI，1.03-1.27）。西班牙裔美国人的门诊就诊次数较少（RR，0.97；95% CI，0.95–0.98）和视网膜神经纤维层 (RNFL) OCT 测试（RR，0.89；95% CI，0.86–0.93），但住院/急诊就诊次数较多（RR , 2.32；95% CI，1.18–4.57）和选择性激光小梁成形术 (SLT)（RR，1.25；95% CI，1.11–1.42）与非西班牙裔白人。在非低 SES 组中，

结论

黑人和西班牙裔青光眼患者在眼科护理利用方面存在差异。在 SES 分层后，这些差异在黑人中持续存在，表明系统性种族主义可能是这一人群的独立驱动因素。