Abstract
Purpose :
There is limited data comparing the frequency of eye care and ophthalmic complications for diabetic patients with Medicare or private health insurance. We performed a retrospective study of medical claims data for patients with diabetes and their matched controls in a large sample of Medicare Advantage (MA) and private sector enrollees.
Methods :
Patients age 50 or older with newly-diagnosed Type 2 diabetes (DM2) from 2007-2015 were recruited from the Optum Clinformatics Database. All patients were tracked for 6 years: 1 year prior to and 5 years after the index diabetes diagnosis. Diabetic patients (n=30,752) were matched to individuals with no diabetes diagnosis (n=27,134) by age, sex, and race. Outcome measures included the receipt of eye care and incidence of ophthalmic complications, including diabetic retinopathy (DR) and diabetic macular edema (DME). Statistical analysis was performed using multivariable logistic regression.
Results :
Diabetic patients were more likely to receive eye exams than non-diabetic patients at 1 (OR 1.880, p<0.01) and 5 years (OR 1.620, p<0.01) after diagnosis, but no more than 40.5% of diabetics received an eye exam in any given year. MA patients were less likely to receive eye exams at 5 years (OR 0.811, p<0.01) than private patients, but also had fewer complications (OR 0.738, p<0.01). Hispanic patients had higher complication rates (OR 1.176, p<0.01) and received fewer eye exams (OR 0.682, p<.01) at 5 years, compared to White patients. Black patients also had higher complication rates (OR 1.444, p<0.01), despite receiving more exams than White patients (OR 1.189, p<0.01). Patients earning over $100K were more likely to receive an eye exam compared with those earning <$40K (OR 1.086, p<0.01), though complication rates were similar. College graduates were more likely to receive eye exams (OR 1.249, p<0.01) and less likely to have complications than patients with a high school (HS) education (OR 0.885, p<0.05).
Conclusions :
The majority of diabetics did not receive an eye exam in any given year. MA patients had fewer exams but also had fewer eye complications compared with privately insured patients. Hispanic, Black, and less educated patients had higher complication rates. Rates of eye care need improvement for all diabetics, especially those in certain socioeconomic groups.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.