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Neil Farbman, Nidhi Talwar, Kristen Harris Nwanyanwu, Nicholas Daniel Chinskey, Joshua D Stein; Racial Disparities in Ancillary Testing for Common Retinal Diseases. Invest. Ophthalmol. Vis. Sci. 2014;55(13):686.
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To determine if ancillary diagnostic testing for macular edema (ME) and neovascular age-related macular degeneration (AMD) varies by race/sex and whether certain demographic groups exhibited greater increases or decreases in utilization of certain tests during 2001-2009.
We reviewed claims data for beneficiaries ≥40yo in a nationwide U.S. managed care network from 2001-2009 to identify enrollees with ME or AMD. Repeated-measures logistic regression was used to determine probability of undergoing optical coherence tomography (OCT) and fluorescein angiography (FA) each year and whether these varied by race/sex, adjusting for sociodemographic characteristics, medical/ocular comorbidities.
31810 persons with ME and 22954 with AMD met the inclusion criteria. In 2001, black males (BM) had the highest probability of getting FA for ME (43%) while Latino females (LF) had the lowest (23%). From 2001-2009, the probability of FA for ME fell most for BM (32%) and least for LF (13%). By 2009 the probability of FA for ME ranged from 7-11% for all groups. By contrast, receipt of OCT for ME was uncommon in 2001 (1-8% probability for all groups) but by 2009 the probability of undergoing OCT for ME rose most for BM (34%) and least for Latino males (LM) (16%) such that probability of OCT for ME was 38% for BM and nearly half that (22%) for LM. In 2001, BM had the highest probability of undergoing FA for AMD (75%) while white females (WF) had the lowest (29%). From 2001-2009, probability of FA for AMD fell most for BM (63%) and least for Asians (14%). By 2009 probability of FA for AMD ranged from 11-19% for all groups. Receipt of OCT was uncommon for AMD in 2001 (1-4% probability for all groups) but by 2009 the probability of undergoing OCT for AMD rose most for WF (33%) and least for LM (19%) such that probability of OCT for AMD was 35% for WF and only 23% for LM.
As trends in ancillary testing for ME and AMD shifted from FA to OCT during 2001-2009, certain demographics were disparately affected relative to others. While many demographic groups exhibited large increases in OCT utilization from 2001-2009, LM had considerably lower probabilities of receiving this test, despite all enrollees possessing health insurance. Future studies will need to identify barriers to testing of Latinos with retinal disease and ways to overcome them.
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