The Association of Social Determinants of Health on Monitoring for Disease Progression Among Patients With Primary Open-Angle Glaucoma.

Abstract

Purpose: To examine the association of race, ethnicity, and other social determinants of health (SDH) on receipt of optic nerve (ON) evaluation in accordance with National Quality Forum (NQF) and the American Academy of Ophthalmology (AAO) guideline-based metrics.

Methods: This was a retrospective cohort study consisting of 13,582 patients with POAG receiving care across 12 tertiary care health. The odds of receiving ≥1 ON evaluations to monitor for glaucoma progression over 45 months of follow-up was evaluated.

Results: White patients (61%) with primary open angle glaucoma (POAG) had more guideline recommended ON evaluations during the 45-month follow-up period, compared with Asian American (52%) and Black (53%) patients (P < 0.001 for both). More non-Hispanic patients with POAG (58%) had ON evaluations in all 3 time periods compared with persons of Latinx ethnicity (52%) (P = 0.045). The odds of undergoing ON evaluations were 17% lower for Black patients compared with White patients (odds ratio [OR] = 0.83; confidence interval [CI], 0.74-0.94), 56% lower for patients living in isolated rural communities (OR = 0.44; CI, 0.25-0.77) compared to urban areas, and 9% lower for patients residing in more impoverished communities (OR = 0.91; CI, 0.86-0.96).

Conclusions: Racial and ethnic minorities and those residing in lesser affluent or rural communities are less likely to receive monitoring for POAG progression in accordance with NQF and AAO guidelines.

Translational relevance: This study aimed to determine the association between SDH and receiving POAG testing according to clinical practice guidelines, with a goal of identifying factors contributing to disparities in care. This should facilitate development of targeted clinical interventions for vulnerable patients with POAG while factoring technology, economic sustainability, and policy.