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Michelle Oboite, Sandra Stinnett, Alan Carlson, Natalie Afshari; Insurance, race, gender and how they relate to visual acuity at the time of cataract surgery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):857.
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To determine if there is any relationship between preoperative visual acuity and sociodemographic variables at the time of cataract surgery
Four hundred thirty candidates for cataract surgery between January 1, 2007 and December 31, 2011 were included in this study. Patient care records were used to collect visual acuity, race, gender, health insurance plans, systemic and ocular comorbidities, body mass index [BMI], and smoking history available from the appointments immediately prior to surgery. Mean preoperative best-corrected visual acuity (BCVA) for cohorts were compared and the significance of differences between race, gender, insurance, and comorbidity groups was assessed using analysis of variance. The relationships between BMI, smoking pack-years, and BCVA were assessed through linear regression. Significant variables were included in a multivariable regression model. The model was then reduced using a stepwise selection procedure.
In univariable analyses of variance, insurance (uninsured, public, private) and race (white, black, other) were the two sociodemographic variables with significant differences between groups (p<0.0001 and p=0.0005, respectively). Pair-wise significant differences in mean preoperative BCVA were found for private (LogMAR 0.451 [Snellen~20/55]) versus public (0.679 [20/75], p=0.0001); private versus uninsured (0.872 [20/150], p=0.0003); white (0.465 [20/60]) versus black (0.674 [20/75], p=0.0008); and white versus other race (0.728 [20/105], p=0.0138). There was no significant difference in BCVA between public and uninsured, black and other race, or men and women, and no strong correlations between BCVA and BMI or smoking pack-years. In a multivariate regression model adjusting for age, significant comorbidities from univariable analyses (diabetes, age-related macular degeneration, and hypertension), and other vision-impairing conditions, insurance and race remained significant (p=0.0056, 0.0038) with the directionality the same as for the univariable analyses.
In this study, patients with private insurance and those of white race independently presented with better preoperative BCVA, on average, than their respective counterparts at the time of cataract surgery. This may represent a disparity in access to care or utilizing the care based on insurance and race variables. Larger studies are needed to confirm these preliminary findings.
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