Characteristics associated with receiving cataract surgery in the United States Medicare and Veterans Health Administration populations

Abstract

Purpose : To identify patient characteristics associated with receiving cataract surgery within the United States (US) Medicare and Veterans Health Administration (VHA) populations.

Methods : Patients with cataract diagnosis were identified from the Medicare Part B files (5% sample) and the VHA National Patient Care Database (NPCD) using an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis code for cataract between 2002 and 2012. Patient age, sex, race, US region of residence, Charlson Comorbidity Index (CCI) scores, and comorbidities were obtained. The occurrence of cataract surgery within 1 and 5 years after diagnosis was defined by Current Procedural Terminology (CPT) codes in the Medicare database and by CPT or ICD-9-CM procedure codes in the VHA database. Adjusted odds ratios (OR) were calculated using logistic regression modeling.

Results : Of the 1,156,211 Medicare and 1,917,254 VHA cataract patients, 414,586 (35.9%) and 240,884 (12.6%) received cataract surgery within 5 years of cataract diagnosis, respectively. Factors associated with increased odds of receiving surgery in both cohorts were older age (Medicare OR 1.24 [95% CI 1.23, 1.24], VHA OR 1.18 [1.17, 1.18], per 5-year increase), residence in the Southern US (Medicare OR 1.38 [1.36, 1.40], VHA OR 1.40 [1.38, 1.41], vs. Eastern US), and chronic pulmonary disease (Medicare OR 1.26 [1.24, 1.27], VHA OR 1.40 [1.38, 1.41]). Factors associated with decreased odds of receiving cataract surgery in both cohorts included black race (Medicare OR 0.79 [0.78, 0.81], VHA OR 0.75 [0.73, 0.76], vs. white race) and dementia (Medicare OR 0.43 [0.42, 0.44], VHA OR 0.83 [0.80, 0.86]).

Conclusions : A greater proportion of patients in Medicare received cataract surgery within 5 years of cataract diagnosis compared with the VHA. Within both groups, older age, residence in the Southern US, and chronic pulmonary disease were associated with increased odds while black race and dementia were associated with decreased odds of receiving cataract surgery. Further studies are needed to examine mechanisms affecting utilization of cataract surgery in these populations.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.