Socioeconomic Disparities in Intravitreal Injection Use and Anti-VEGF Agent Selection: Aflibercept/Ranibizumab Versus Bevacizumab.

Purpose: There is a paucity of research on socioeconomic factors associated with intravitreal injection use or type of anti-vascular endothelial growth factor (anti-VEGF) use. The purpose of this cross-sectional analysis is to examine the association between demographic and socioeconomic factors and intravitreal injections and type of anti-VEGF (bevacizumab, aflibercept, and ranibizumab) use for patients with diabetic macular edema, proliferative diabetic retinopathy, retinal vein occlusion, and wet age-related macular degeneration in the AllofUs Database, which is a nationwide health database initiative conducted by the National Institutes of Health in the United States to enroll participants from groups that are considered to be historically underrepresented in biomedical research.

Methods: The study population included patients diagnosed with diabetic macular edema, proliferative diabetic retinopathy, retinal vein occlusion, or wet age-related macular degeneration based on the International Classification of Diseases Ninth/10th Revision, Clinical Modification diagnosis codes. Exposures included age, sex, race/ethnicity, income, and education. Outcomes included IVI use based on the Current Procedural Terminology 4 codes and anti-VEGF type based on RxNorm codes.

Findings: Of 3010 participants, 25.9% ever had IVI use. In multivariate logistic regression analyses, those with older age (adjusted odds ratio [aOR] = 1.27; 95% CI, 1.18-1.37) and income >$150,000 (aOR = 1.71; CI, 1.27-2.32) were more likely to have had IVI use. Those with older age (aOR = 1.46; CI, 1.22-1.75), Asian/other race/ethnicity (aOR = 3.81; CI, 1.09-13.34), Hispanic race/ethnicity (aOR = 3.16; CI, 1.59-6.26), income >$150,000 (aOR = 3.20; CI, 1.45-7.06), and college graduate/advanced degree (aOR = 1.83; CI, 1.01-3.31) were more likely to have aflibercept/ranibizumab only versus bevacizumab use.

Implications: Interventions are needed to increase health literacy and access to IVI for at-risk, low-income populations. Future research should investigate patient and provider decision-making for anti-VEGF drug choice, which may have implications for cost-saving measures and policies.