Socioeconomic and Demographic Disparities in Keratoconus Treatment

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2024-11-30 DOI:10.1016/j.ajo.2024.11.023

Rohith Erukulla , Mohammad Soleimani , Maria Woodward , Niranjan Karnik , Charlotte Joslin , Timothy McMahon , Angelica Scanzera , Ellen Shorter , Hannah Yoon , Maria Cortina , Jose de la Cruz , Sandeep Jain , Hajirah N. Saeed , Elmer Tu , Mark Rosenblatt , Ali Djalilian

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引用次数: 0

Abstract

PURPOSE

To investigate healthcare disparities associated with keratoconus (KCN) patients receiving treatment (corneal cross-linking [CXL] and keratoplasty), as well as comorbidities associated with KCN.

DESIGN

Retrospective clinical cohort study.

METHODS

A total of 3224 patients from the University of Illinois Hospital & Health Sciences System (UI-Health) database from 2020 to 2024 were examined, including 1612 patients with an International Classification of Diseases, Tenth Revision diagnosis of KCN, and 1612 ophthalmology patients as a control group. Multivariable and univariable logistic regression were performed to evaluate the associations between sociodemographic traits and rates of CXL and keratoplasty. Sociodemographic traits included age, sex, race/ethnicity, insurance status, and neighborhood social vulnerability. Best corrected visual acuity (BCVA) and manifest cylinder were used as indicators of disease impact. Comorbid disease rates were compared to a 1:1 distance-matched control group. Main outcome measures were odds ratio of undergoing keratoplasty and CXL, and prevalence of comorbid conditions.

RESULTS

Female individuals received less keratoplasty than male individuals (odds ratio [OR] = 0.55, P < .001). Black individuals received less CXL than White individuals (OR = 0.68, P < .05), as did individuals with Medicaid (OR = 0.27, P < .0001) or no insurance (OR = 0.41, P < .001) compared to those with commercial insurance. Individuals from socially vulnerable neighborhoods received less CXL (OR = 0.56, P < .01) and keratoplasty (OR = 0.66, P < .05). Black female individuals were the most vulnerable, undergoing fewer procedures than White female (OR = 0.58, P < .01) and Black male (OR = 0.65, P < .05) individuals. Black and Hispanic/Latin-X individuals presented with more severe disease (P < .01, P < .0001). Down syndrome was more common (P < .01), and diabetes was less common (P < .0001), in KCN patients.

CONCLUSIONS

Significant sociodemographic disparities exist in the treatment of KCN. Although further research is necessary, addressing these disparities is crucial for ensuring equitable access to care.

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圆锥角膜治疗的社会经济和人口差异。

目的：探讨圆锥角膜（KCN）患者接受治疗（胶原交联（CXL）和角膜移植术）的保健差异，以及与KCN相关的合并症。设计：回顾性临床队列研究。研究对象：来自2020 - 2024年uni - health数据库的3224例患者，其中ICD-10诊断为KCN的患者1612例，眼科患者1612例作为对照组。方法：采用多变量和单变量logistic回归评估社会人口学特征与角膜移植和角膜移植的相关性。社会人口学特征包括年龄、性别、种族/民族、保险状况和社区社会脆弱性。以最佳矫正视力（BCVA）和表柱作为疾病影响的指标。共病率与1:1距离匹配对照组比较。主要结局指标：接受角膜移植和CXL的优势比，以及合并症的患病率。结果：女性接受角膜移植术的人数少于男性（OR=0.55, p）。结论：KCN的治疗存在显著的社会人口差异。虽然需要进一步研究，但解决这些差异对于确保公平获得护理至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.