Abstract
Abstract: :
Purpose:Age–related cataract remains a leading cause of visual impairment in the United States. Cataract extraction is the most frequently performed operation in the Medicare population, and cataract surgery rates are expected increase appreciably over the next two decades. Few published studies have reported cataract surgery rates, and many of these studies do not reflect the most current innovations in cataract surgery technology and changes in reimbursement. This study analyzes cataract surgery rates between 1996 and 2002 and assesses factors related to variation in the probability of receiving cataract surgery. Methods: A longitudinal, national panel study was used to determine the rates of cataract surgery between 1996 and 2002 (Revised Health and Retirement Study). The strength of the data is national coverage, the longitudinal feature, and the presence of detailed information on socioeconomic factors, including supplemental insurance coverage to Medicare. Self–report data were obtained by interviews from individuals 65 and older in 1998, 2000, and in 2002 (n=22,160) to determine if these individuals had undergone cataract extraction in one or both eyes in the previous two years. Multivariate analysis was used to identify factors affecting the rates of cataract surgery. Results: Rates of cataract surgery were similar for the time periods between 1996 and 2002, including the specific time periods of 1998–1999 and 2000–2001 (OR=0.968 p=0.559 vs. OR=0.879, p=0.026). The likelihood of having cataract surgery was greatest for persons still employed and who had regular insurance (p=0.047, OR=1.243). Those with supplemental Medicare also appeared to have higher rates of cataract surgery (p=0.001, OR=1.194). Individuals who described their vision as "fair to poor" at the beginning of a two–year period were also likely to have cataract surgery within the two–year period (p=0.000, OR=1.998). Black patients were not as likely to undergo cataract surgery (p=0.033, OR=0.8488), holding constant other factors such as age and assessment of visual function. Conclusions: Recent rates of cataract surgery appear to be strongly correlated with insurance status, vision, overall health, and race. Additional research is needed to understand the reasons for these disparities among the elderly, such as the difference in cataract surgery utilization rates between blacks and whites even when controlling for other factors. Further understanding of these factors related to longitudinal cataract surgery utilization rates will provide key insights into addressing the growing demand of cataract care in the next 20 years.
Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower • clinical (human) or epidemiologic studies: prevalence/incidence • cataract