Why Do African Americans Have Less Cataract Surgery? SEE Project

Abstract

Purpose: : African Americans are about 1/3 less likely to have cataract surgery, compared to Caucasians of the same age and gender. The reasons for the disparity are unclear. The purpose of this study was to determine the contribution of vision, cataract type, self–reported function and performance on functional tests to differences in cataract surgery between the races.

Methods: : The SEE project is a population–based study of 2520 persons age 65 to 84 in Salisbury Maryland who have been followed over eight years. Cataract surgery was assessed at each of three rounds of follow up. Baseline assessment of type and severity of lens opacity was based on photographs; visual acuity was assessed using ETDRS charts; self–report of vision difficulty was based on the ADVS score; standardized performance based tests were administered. Education, smoking, and diabetes were based on questionnaire (the latter also based on laboratory assessment of HgA₁C). Time to first eye cataract surgery was determined by race, and Cox regression analyses were used to analyze explanatory factors. Persons were censored if they left the study, died, or at study conclusion. An event was cataract surgery in the first eye.

Results: : Of the 2520 participants, 2035 had both eyes which had not had cataract surgery at baseline. Over eight years, 416 persons had cataract surgery in their first eye. Adjusting for age and sex, the hazard ratio for cataract surgery among African Americans was 0.67 (95% CI=0.53–0.86) compared to Caucasians. Nuclear, cortical, mixed and PSC opacity at baseline predicted cataract surgery, as did acuity loss, self –report of difficulty, diabetes, and smoking but none of these factors explained the disparity. Educational level was not predictive. Previous contact with the eye care system increased the hazard ratio (1.35, 95%CI=1.07–1.71) for cataract surgery, but did not explain the disparity, which remained at 0.59 (95% CI=0.45–0.78)

Conclusions: : Differences in vision, self–perception of disability, or contact with the eye care system did not explain the disparity between African Americans and Caucasians in use of cataract surgery services.

Keywords: cataract • clinical (human) or epidemiologic studies: health care delivery/economics/manpower