Epidemiology of Corneal Ulcers Diagnosed in the Emergency Department in California.

Abstract

Purpose: To determine the incidence, seasonality, geographic distribution, and risk factors for emergency department presentations with corneal ulcers and perforated corneal ulcers.

Methods: Retrospective, population-based cohort study of corneal ulcers in California from 2012 to 2021. Overall and stratified yearly incidence rates, seasonality, individual-level and postal code-level risk factors for perforation, and geographic clustering were evaluated.

Results: This study included 31,019 emergency department (ED) visits for corneal ulcers, with 263 cases coded as perforated corneal ulcers. The average yearly incidence was 7.94 (95% confidence interval, 7.85-8.03) per 100,000 people for ED-diagnosed corneal ulcers and 0.67 (95% confidence interval, 0.59-0.76) per 1,000,000 people for perforated corneal ulcers. Male patients, Black patients, and primary English-speaking patients had the highest incidences across sociodemographic groups. For ED-diagnosed corneal ulcers, the incidence was highest among individuals aged 20 to 60 and for perforated corneal ulcers the incidence was highest among individuals over age 75. Significant geographic clustering was observed, with hotspots in the Central Valley and inland Northern and Southern California. Visits were seasonal, with incidence peaking in July and lowest in February. Increasing age, Spanish as a preferred language, and having health insurance were significant risk factors for presenting with a perforated corneal ulcer. Indicators of low socioeconomic status were associated with higher rates of corneal ulcers.

Conclusions: The incidence of ED-diagnosed corneal ulcers in California increased over the study period with a notable seasonal pattern. Higher rates were observed in Black individuals and in areas with lower socioeconomic status, providing evidence of health disparities and identifying potential targets for public health interventions.