Racial and Socioeconomic Differences in Eye Care Utilization among Medicare Beneficiaries with Glaucoma
Open accessAbstract
Purpose Evaluate differences in eye care utilization among patients with glaucoma by race and socioeconomic status (SES).Design Retrospective cohort study.Participants Representative 5% sample of Medicare beneficiaries aged > 65 years with continuous part A/B enrollment between January 1, 2014, and July 1, 2014, at least 1 diagnosis code for glaucoma within that period, and a glaucoma diagnosis in the Chronic Conditions Warehouse before January 1, 2014.Methods The following race/ethnicity categories were defined in our cohort: non-Hispanic White, Black/African American, Hispanic, and Asian/Pacific Islander. Low SES was defined as having 2 or more enrollment-based low-income indicators (dual eligibility for Medicare/Medicaid, Part D limited income subsidies, and eligibility for Part A and B State buy-in). Negative binomial regression analyses were carried out to compare relative rate ratios (RRs) of eye care utilization among racial groups stratified by low and non-low SES.Main outcome measures Measured from July 1, 2014, to December 31, 2016: eye examinations and eye care-related office visits; eye care-related inpatient and emergency department (ED) encounters; eye care-related nursing home and home-visit encounters; visual field and retinal nerve fiber OCT tests; glaucoma lasers and surgeries.Results Among 78 526 participants with glaucoma, mean age was 79.1 years (standard deviation, 7.9 years), 60.9% were female, 78.4% were non-Hispanic White, and 13.8% met enrollment-based criteria for low-SES. Compared with White beneficiaries, Blacks had lower counts of outpatient visits (RR, 0.92; 95% confidence interval [CI], 0.90-0.93), visual field (VF) tests (RR, 0.92; 95% CI, 0.90-0.94), but more inpatient/ED encounters (RR, 2.42; 95% CI, 1.55-3.78) and surgeries (RR, 1.14; 95% CI, 1.03-1.27). Hispanics had fewer outpatient visits (RR, 0.97; 95% CI, 0.95-0.98) and retinal nerve fiber layer (RNFL) OCT tests (RR, 0.89; 95% CI, 0.86-0.93), but more inpatient/ED encounters (RR, 2.32; 95% CI, 1.18-4.57) and selective laser trabeculoplasty (SLT) (RR, 1.25; 95% CI, 1.11-1.42) versus non-Hispanic Whites. In the non-low SES group, Black versus White disparities persisted in outpatient visits (RR, 0.93; 95% CI, 0.92-0.95), VF (RR, 0.96; 95% CI, 0.94-0.98), RNFL OCT (RR, 0.81; 95% CI, 0.78-0.83), and inpatient/ED encounters (RR, 2.57; 95% CI, 1.55-4.26).Conclusions Disparities were found in eye care utilization among Black and Hispanic patients with glaucoma. These differences persisted among Blacks after stratification by SES, suggesting that systemic racism may be an independent driver in this population.
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Visual Field Progression in Glaucoma Patients With Delayed Follow-Up
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Self-citationOutcomes of Sutureless Ahmed Glaucoma Valve Surgery: A Retrospective Study
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Socioeconomic and Racial Disparities in Primary Open Angle Glaucoma in the United States
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Predictors of Glaucoma Conversion in an African Ancestry Cohort: A Longitudinal Study
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Glaucoma in Black Individuals: How Far Have We Come and Where Do We Go From Here?
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Social Factors Associated with the Risk of Glaucoma Suspect Conversion to Glaucoma
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Importance of Bilateral Visualization in Congenital Dacryocystocele
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Effects of Cost Sharing on Ophthalmic Care Utilization in the Affordable Care Act Marketplace
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Visual Field and RNFL OCT Testing Among Rural and Urban Residents With Glaucoma
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- Authors
- Halawa, O. A., Kolli, A., Oh, G., Mitchell, W. G., Glynn, R. J., Kim, D. H., Friedman, D. S., & Zebardast, N.
- Affiliations
- Massachusetts Eye and Ear Infirmary (US)
- Harvard University (US)
- Hebrew SeniorLife (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Zebardast, Nazlee
- ORCID
- Venue
- Ophthalmology
- Publisher
- Elsevier BV
- Published
- 2022-04
- Volume
- 129
- Issue
- 4
- Pages
- 397-405
- ISSN
- 0161-6420 (ISSN-L)
- PMC
- PMC8940630
- OpenAlex
- W3203726949
- Cited by
- 92
- References
- 39
- Citations by year
- 2026: 12 · 2025: 19 · 2024: 26 · 2023: 23 · 2022: 12
- FWCI
- 13.69
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Eye Institute
- Topics
- Health Sciences › Medicine › Ophthalmology › Glaucoma and retinal disorders
- Health Sciences › Medicine › Epidemiology › Ophthalmology and Visual Impairment Studies
- Health Sciences › Medicine › Ophthalmology › Ophthalmology and Visual Health Research
- Keywords
- glaucoma, eye care utilization, racial disparities, socioeconomic status, Medicare beneficiaries, older adults, Black patients, Hispanic patients, visual field testing, glaucoma surgery, emergency department visits, nursing home visits, home visits, health care access, quality of care
- MeSH terms
- Aged, Female, Glaucoma, Medicare, Humans, Male, Retrospective Studies, Social Class, United States, Healthcare Disparities
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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