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Racial and socioeconomic differences in eye care utilization among Medicare beneficiaries with glaucoma
Ophthalmology  (IF12.079),  Pub Date : 2021-10-06, DOI: 10.1016/j.ophtha.2021.09.022
Omar A. Halawa, Ajay Kolli, Gahee Oh, William G. Mitchell, Robert J. Glynn, Dae Hyun Kim, David S. Friedman, Nazlee Zebardast

Purpose

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

Design

Retrospective cohort study.

Subjects

Representative 5% sample of Medicare beneficiaries >65 years with continuous part A/B enrollment between 1/1/2014 and 7/1/2014, at least one diagnosis code for glaucoma within that period, and a glaucoma diagnosis in the Chronic Conditions Warehouse before 1/1/2014.

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 two 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 (RR) of eye care utilization among racial groups, stratified by low- and non-low-SES.

Main outcome measures

Measured from 7/1/2014-12/31/2016: eye examinations and eye care-related office visits; eye care-related inpatient and ED encounters; eye care-related nursing home and home-visit encounters; visual field and retinal nerve fiber optical coherence tomography tests; glaucoma lasers and surgeries.

Results

Among 78,526 participants with glaucoma, mean age was 79.1 years (SD 7.9 years), 60.9% were female, 78.4% were non-Hispanic White and 13.8% met enrollment-based criteria for low-SES. Compared to White beneficiaries, Blacks had lower counts of outpatient visits (rate ratio [RR] 0.92, 95% CI 0.90-0.93), 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 1.03-1.7). Hispanics had fewer outpatient visits (RR 0.97, 95% CI 0.95-0.98) and 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 SLT (RR 1.25, 95% CI 1.11-1.42) vs. non-Hispanic Whites. In the non-low-SES group, Black vs. 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 glaucoma patients. These differences persisted among Blacks after stratification by SES, suggesting systemic racism may be an independent driver in this population.