Association Between Sociodemographic Risk Factors and No-Show Propensity in a Glaucoma Population Before and During COVID-19 Pandemic.

Abstract

Prcis: Greater social vulnerability, younger age, nonwhite race, Hispanic ethnicity, non-English speaking, Medicaid insurance, and milder glaucoma were associated with a higher no-show propensity, which worsened during the COVID-19 pandemic among those subjects who were older and more socially vulnerable.

Purpose: To identify sociodemographic risk factors for a higher likelihood to no-show among glaucoma subjects before and during the COVID-19 pandemic using the no-show propensity factor (NSPF), a novel attendance metric, which improves upon no-show percentages by adjusting for number of visits.

Methods: We analyzed deidentified demographic, visit attendance, and social risk factor data [social vulnerability index (SVI) and area deprivation index (ADI) scores] of deidentified glaucoma subjects from the Bascom Palmer Glaucoma Repository, computed NSPF, and categorized scores as low, intermediate, or high by the 75th and 90th percentiles for the prepandemic and pandemic periods. We identified predictors of NSPF scores using univariable, multivariable, and logistic regression analyses.

Results: Of 15,342 subjects, 11,474, 2238, and 1630 subjects had low, intermediate, and high NSPF scores, respectively, with no-show rates of 9.5%, 39.2%, and 57.8%, respectively. Age (β=-0.039 per decade, P <0.001), Black race (β=0.152, P <0.001), Hispanic ethnicity (β=0.115, P <0.001), Medicaid (β=0.073, P <0.001), Spanish primary language (β=0.076, P <0.001), SVI scores (β=0.047 per 25% increase, P <0.001), ADI ranking (β=0.057 for highest quartile, P <0.001), and baseline moderate (β=-0.046, P <0.001) or severe (β=-0.077, P <0.001) glaucomatous disease were significant predictors of NSPF. Older age [odds ratio (OR) 1.15 per decade, P <0.001], higher overall SVI (OR: 1.09 per 25% increase, P <0.001), Medicare/Tricare insurance (OR: 1.13, P =0.044), and non-English/Spanish primary language (OR: 1.43, P =0.020) were associated with worsening NSPF during the pandemic.

Conclusion: Younger age, nonwhite race, Hispanic ethnicity, non-English primary language, Medicaid, milder glaucoma, and residence in vulnerable areas are risk factors for greater propensity to no-show.