社会经济地位调节和改变切口青光眼手术结果的种族差异。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-03-10 DOI:10.1016/j.ajo.2025.03.006

Ken Kitayama , Yusuke Tsugawa , Akihiro Nishi , Anne L. Coleman

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引用次数: 0

摘要

目的：估计在青光眼手术结果中观察到的种族和民族差异的比例，这些差异可以通过抑制社会经济地位（SES）的差异来消除。设计：回顾性队列研究。研究对象：2016-2018年加利福尼亚州（CA）按服务收费的医疗保险受益人，索赔切口青光眼手术（小梁切除术、管分流术或EX-PRESS分流术）的全部人群。方法：主要暴露于种族和民族，分层为：非拉丁裔白人（作为参考类别），黑人，拉丁裔，亚洲/太平洋岛民（PI）和其他。基于医疗补助的双重资格，SES中介被分为低与非低。结果（到失败事件发生的时间）定义为对青光眼手术翻修或再手术事件提出索赔。主要结果测量：总效应（total effect， TE）估计了整个种族和民族差异。控制直接效应（CDE）估计了将所有SES固定为非低后的剩余差距，消除比例（PE）估计了均匀SES分配后消除的差距比例。TE和CDE估计值被解释为使用Cox比例风险的时间-事件模型的风险比。结果：最终的分析样本包括总共5,985个独特的CA受益人。将SES统一固定为非低后，黑人患者的种族和民族差异消散最多(TE: 1.18, 95% CI: 0.99-1.41；CDE: 1.01, 95% CI: 0.80-1.77)，其次是拉丁裔患者(TE: 1.23, 95% CI: 1.08-1.51；CDE: 1.10, 95% CI: 0.90-1.35)，其他人种和民族患者(TE: 1.32, 95% CI: 1.03-1.70；CDE: 1.24, 95% CI: 0.91-1.68)，亚洲/PI患者(TE: 1.18, 95% CI: 1.02-1.36；Cde: 1.21, 95% ci: 0.99-1.47)。PE估计表明，平衡SES将消除不同程度的差异，黑人患者的最大差异为96% (PE: 0.96, 95% CI: -0.27-2.19)，其次是拉丁裔患者的54% (PE: 0.54, 95% CI: -0.25-1.33)，其他种族和民族（PE: 0.24, 95% CI: -0.49-0.97）和亚洲/PI患者（PE: -0.18, 95% CI: -1.11-0.75）没有显著变化。结论：我们发现SES介导了青光眼手术结果的种族和民族差异，尽管其影响程度因种族和民族而异。值得注意的是，解决社会经济地位的差异将消除96%的黑人受益者的差距。

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Socioeconomic Status Mediates and Modifies Racial and Ethnic Disparities in Incisional Glaucoma Surgical Outcomes

PURPOSE

To estimate the proportion of racial and ethnic disparities observed in glaucoma surgical outcomes that can be eliminated by curbing differences in socioeconomic status (SES).

DESIGN

Retrospective cohort study.

SUBJECTS

The entire population of 2016-2018 California (CA) fee-for-service Medicare beneficiaries with a claim for incisional glaucoma surgery (trabeculectomy, tube shunt, or EX-PRESS shunt).

METHODS

The primary exposure was race and ethnicity, stratified into: Non-Latinx White (as the reference category), Black, Latinx, Asian/Pacific Islander (PI), and Other. The SES mediator was dichotomized to low vs. nonlow based on dual-eligibility for Medicaid. Outcome (time to failure event) was defined as having a claim for a glaucoma surgery revision or reoperation event.

MAIN OUTCOME MEASURES

The total effect (TE) estimated the entire racial and ethnic disparity. The controlled direct effect (CDE) estimated the remaining disparity after fixing SES to nonlow for all, and the proportion eliminated (PE) estimated the proportion of the disparity eliminated after uniform SES assignment. The TE and CDE estimates are interpreted as hazards ratios given time-to-event modeling using Cox proportional hazards.

RESULTS

The final analytical sample included a total of 5985 unique CA beneficiaries. After uniformly fixing SES to nonlow, the racial and ethnic disparity for Black patients dissipated most (TE: 1.18, 95% CI: 0.99-1.41; CDE: 1.01, 95% CI: 0.80-1.77), followed by Latinx patients (TE: 1.23, 95% CI: 1.08-1.51; CDE: 1.10, 95% CI: 0.90-1.35), Other race and ethnicity patients (TE: 1.32, 95% CI: 1.03-1.70; CDE: 1.24, 95% CI: 0.91-1.68), and Asian/PI patients (TE: 1.18, 95% CI: 1.02-1.36; CDE: 1.21, 95% CI: 0.99-1.47). The PE estimates suggest that equalizing SES would eliminate varying levels of disparities, with a maximum of 96% for Black patients (PE: 0.96, 95% CI: −0.27 to 2.19), followed by 54% for Latinx patients (PE: 0.54, 95% CI: −0.25 to 1.33), and no significant change for Other race and ethnicity (PE: 0.24, 95% CI: −0.49 to 0.97), and Asian/PI patients (PE: −0.18, 95% CI: −1.11 to 0.75).

CONCLUSIONS

We found that SES mediates racial and ethnic disparities in glaucoma surgical outcomes, though by varying amounts by individual racial and ethnic group. Of note, addressing SES differences would eliminate 96% of the disparity for Black beneficiaries.

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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.