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Joshua D. Stein, Nidhi Talwar, Alejandra M. Laverne, Bin Nan, Paul R. Lichter; Racial and Sex Disparities in the Use of Diagnostic Testing to Evaluate Individuals with Open-Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5316.
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To determine whether racial and sex disparities exist in the use of diagnostic procedures to evaluate individuals with open-angle glaucoma (OAG) who were enrolled in a large US managed care network from 2001-2009.
All individuals age ≥40 enrolled in a managed care network who had OAG were identified. Repeated measures logistic regression was performed to determine the odds each year of undergoing visual field (VF) testing, ocular imaging (OI), and fundus photography (FP) for black, white, Latino, and Asian American males and females, adjusting for other sociodemographic factors, ocular and nonocular comorbidities.
Among the 149,018 enrollees with OAG, there were 15,905 blacks, 118,062 whites, 9,376 Latinos, and 4,350 Asian Americans. The odds of undergoing VF testing decreased for all groups from 2001-2009. The odds of undergoing VF testing decreased most (63%) from 2001 to 2009 for Latino males (adjusted OR =0.37, 95% CI 0.31-0.43) and least (39%) for Asian males (OR=0.61, CI 0.49-0.77). In 2009, black females had the highest probability of undergoing VF testing (59%) while Latino males had the lowest (44%). By comparison, the odds of undergoing OI increased for all groups from 2001-2009. The odds of undergoing OI increased most (130%) over the decade for black males (adjusted OR =2.30, CI 1.95-2.73) and black females (127%) (OR = 2.27, CI 1.97-2.63) and least (56%) for Latino females (OR=1.56, CI 1.32-1.85) and Latino males (75%) (OR = 1.75, CI 1.45-2.11). In 2009, the probability of receiving OI was highest in black males (54%) and females (54%) and lowest in Latino males (41%) and females (41%). Probabilities of undergoing FP were low for all groups and did not change much throughout the decade.
From 2001-2009, there have been dramatic changes in the use of diagnostic testing for OAG with considerable increases in the use of OI coupled with decreases VF testing for all groups. Latino males and females demonstrated considerably lower odds of undergoing VF testing and OI compared with other groups. Given that Latinos are the fastest growing racial minority, efforts need to be made to better understand why Latinos are not receiving similar levels of monitoring for OAG relative to other groups.
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