Abstract
Purpose :
To examine the distribution of procedural glaucoma treatments by ethnicity in the California (CA) Medicare population, and to examine predictors of receiving procedural glaucoma treatment in Hispanics within this population.
Methods :
The study population included 2015 CA Medicare beneficiaries with an International Classification of Diseases (ICD-9 or 10-CM) diagnosis code for primary open angle glaucoma (POAG). Demographics included age, sex, and ethnicity, which was classified as white, black, Hispanic, Asian, or other. Systemic comorbidity was summarized using the Charlson Comorbidity Index (CCI), which was based on ICD-9 or 10-CM diagnosis codes. Glaucoma surgeries were defined by Current Procedural Terminology (CPT) codes for trabeculectomy and aqueous shunt. Glaucoma laser was defined by the CPT code for selective laser trabeculoplasty (SLT). Unadjusted comparisons were performed using chi-squared tests. Logistic regression modeling was used to examine multivariable predictors for glaucoma surgery and laser in Hispanics with POAG, including all study covariates as potential predictors.
Results :
Among 159,282 patients with POAG, there were 1,775/94,846 (1.9%) white, 370/10,963 (3.4%) black, 422/23,167 (1.8%) Asian, 553/25,791 (2.1%) Hispanic, and 79/4,515 (1.8%) patients of other ethnicity who received glaucoma surgery (p<0.0001), and 5,062/94,846 (5.3%) white, 547/10,963 (5.0%) black, 1,496/23,167 (6.5%) Asian, 2,081/25,791 (8.1%) Hispanic, and 260/4,515 (5.8%) patients of other ethnicity who received SLT (p<0.0001). In Hispanics with POAG, multivariable predictors of receiving surgery included older age (odds ratio [OR]=0.57, 95% confidence interval [CI]=0.38, 0.86 for age 90+ years old versus 65-69 years old) and female (OR=0.80, 95% CI=0.68, 0.95). Multivariable predictors of receiving SLT included ages of 85-89 years old (OR=0.83, 95% CI=0.70, 0.98) and 90+ years old (OR=0.52, 95% CI=0.42, 0.65) compared to age 65-69 years old, and CCI of 1-2 (OR=1.19, 95% CI=1.05, 1.36) and 3-4 (OR=1.22, 95% CI=1.06, 1.41) compared to CCI of 0.
Conclusions :
In the CA Medicare population, Hispanics may have higher rates of glaucoma laser treatment compared to other ethnicities. In Hispanics with glaucoma, female sex may be associated with lower odds of incisional surgery, while moderate systemic disease burden may be associated with higher odds of laser.
This is a 2020 ARVO Annual Meeting abstract.