Leveraging Sight Outcomes Research Collaborative (SOURCE) Data to Predict Initial Presentation with Advanced Open-Angle Glaucoma.

IF 4.2 1区 医学 Q1 OPHTHALMOLOGY
Rithambara Ramachandran,Aaron T Zhao,Yinxi Yu,Paula Anne Newman-Casey,Joshua D Stein,
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引用次数: 0

Abstract

PURPOSE To investigate factors associated with initial presentation at tertiary health systems with advanced primary open-angle glaucoma (OAG) in either eye. DESIGN Cross-sectional study. SUBJECTS Adults>40 years old diagnosed with OAG initially presenting at one of eleven SOURCE consortium sites between 2016 and 2023. METHODS OAG severity was dichotomized as "non-advanced" (suspect, mild, moderate) or "advanced," based on the most severe stage in either eye within one year of presentation using ICD-10 codes. Logistic regression identified sociodemographic and neighborhood factors linked to "advanced" OAG presentation, and ordinal models assessed predictors by stage. Predictors included sociodemographic characteristics, health insurance type, income, education, urbanicity, and neighborhood-level affluence (Distressed Communities Index [DCI]). Associations with intraocular pressure (IOP) and cup-to-disc ratio (CDR) were modeled for all eyes using linear regression with generalized estimating equations. MAIN OUTCOME MEASURES Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for factors associated with presenting with "advanced" OAG. RESULTS Among 59,409 individuals, 7,560 (12.7%) presented with advanced OAG in at least one eye. Mean age was 65.8(SD 12.7) years; 44.6% male, 56.7% Caucasian. Older age per decade (aOR: 1.74, 95% CI: 1.70-1.78), male sex (aOR: 1.59, CI: 1.51-1.68), Black race (aOR: 1.67, CI: 1.56-1.80), less affluent communities (aOR: 1.04 per 10-unit DCI increase, CI: 1.03-1.05), and non-metropolitan residence (OR range: 1.42-1.99) were associated with advanced presentation. Protective factors included Medicare insurance (aOR: 0.90, CI: 0.90-0.96), higher education (aOR range: 0.74-0.83), and diabetes mellitus (aOR: 0.39, CI: 0.36-0.43). Results were consistent across secondary analyses. Presenting IOP and CDR increased with disease severity and were similarly associated with sociodemographic and neighborhood factors. CONCLUSION Identifying sociodemographic predictors of late presentation using large population-based datasets may help inform targeted glaucoma screening efforts, since delayed initial presentation is a major risk factor for vision loss from advanced OAG.
利用视力结果研究合作(SOURCE)数据预测晚期开角型青光眼的初始表现。
目的:探讨与在三级医疗系统就诊的单眼晚期原发性开角型青光眼(OAG)患者初始表现相关的因素。DESIGNCross-sectional研究。受试者:在2016年至2023年期间,在11个SOURCE联盟站点之一首次出现诊断为OAG的40岁至40岁的成年人。方法采用ICD-10编码,根据出现后一年内任意一只眼睛的最严重阶段,将soag严重程度分为“非晚期”(疑似、轻度、中度)或“晚期”。逻辑回归确定了与“晚期”OAG表现相关的社会人口统计学和社区因素,顺序模型按阶段评估预测因子。预测因素包括社会人口特征、健康保险类型、收入、教育、城市化程度和社区富裕程度(贫困社区指数[DCI])。所有眼的眼内压(IOP)和杯盘比(CDR)的相关性使用广义估计方程的线性回归建模。主要结局指标与出现“晚期”OAG相关因素的校正优势比(aor)和95%可信区间(CIs)。结果59,409例患者中,有7,560例(12.7%)至少有一只眼出现晚期OAG。平均年龄65.8岁(SD 12.7);男性44.6%,白种人56.7%。每十年年龄较大(aOR: 1.74, 95% CI: 1.70-1.78)、男性(aOR: 1.59, CI: 1.51-1.68)、黑人(aOR: 1.67, CI: 1.56-1.80)、较不富裕社区(aOR: 1.04 / 10单位DCI增加,CI: 1.03-1.05)和非大都市居住(OR范围:1.42-1.99)与晚期症状相关。保护因素包括医疗保险(aOR: 0.90, CI: 0.90-0.96)、高等教育(aOR范围:0.74-0.83)和糖尿病(aOR: 0.39, CI: 0.36-0.43)。二次分析的结果是一致的。IOP和CDR随疾病严重程度的增加而增加,并与社会人口统计学和邻里因素相似。结论:使用基于人群的大型数据集确定迟见的社会人口统计学预测因素可能有助于有针对性地开展青光眼筛查工作,因为迟见是晚期OAG导致视力丧失的主要危险因素。
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来源期刊
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.
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