Tell us where you live and we will tell you something about your glaucoma

Abstract

 

Purpose

 

We use modern geodemographic tools to interrogate large volumes of patient data to examine factors that are associated with late presentation of disease and poor adherence to follow-up in glaucoma.

 

Methods

 

Over 500,000 Humphrey visual fields (VFs) recorded in four regionally different glaucoma clinics/services in England (Cheltenham, Huddersfield, London and Portsmouth) in the last decade were retrospectively investigated. Surrogate measures for late presentation of glaucoma and adherence to treatment were estimated by a patient’s VF damage (mean deviation [MD] at first visit) and frequency of VF tests respectively. Socioeconomic status and consumer/community segmentation data was defined by patients’ postcodes (ZIP codes) using the IMD (Index of Multiple Deprivation) and ACORN (A Classification Of Residential Neighbourhoods) geodemographic tools.

 

Results

 

Data from 57090 patients were analysed. There were strong links between geodemographic measures of socioeconomic status and later presentation of disease. There was significant correlation between MD at presentation and IMD score (Spearman’s rho = -0.20; p < 0.0001; partial correlation corrected for age); geodemographic maps highlight this relationship (see figure). Patients from the least deprived areas, on average, are predicted to present with significantly less MD damage (MD = -5 dB; 95% confidence interval [CI] = -4 to -6 dB) than patients from the most deprived regions (MD = -9 dB; 95% CI = -8 to -10 dB). Other associations between socioeconomic status and a surrogate measure for adherence to treatment were indicated. Other geodemographic maps reveal relationships between late detection of disease and proximity to primary health care providers (optometrists).

 

Conclusions

 

‘Big data’ from glaucoma clinics can be used to reveal associations between socioeconomic status, late presentation of disease and adherence to follow-up care. Interactive geodemographic mapping tools can help illuminate public health requirements for glaucoma.

 

 

Figure: Maps of central London showing severity of visual field loss at presentation and index of multiple deprivation score. Darker areas correspond to areas where patients live that present with more severe disease and have worse socioeconomic status. Note the striking spatial concordance between the shading of these maps.

 

Keywords: 758 visual fields • 460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower • 459 clinical (human) or epidemiologic studies: biostatistics/epidemiology methodology