Characterizing how Racial and Socioeconomic Factors Affect Anti-VEGF Treatment Utilization and Outcomes for Diabetic Macular Edema

Abstract

Purpose : Although it is clear that minorities and people of low socioeconomic status are at greater risk of developing Diabetic Macular Edema (DME), it is unclear the extent to which these high-risk groups experience a difference in follow-up treatment post-diagnosis of DME. This retrospective cohort study compares anti-vascular endothelial growth factor (anti-VEGF) injection utilization and outcomes for DME among minority groups and patients of various socioeconomic statuses.

Methods : Charts of patients seen at a single institution between April 2012 and December 2017 were collected, yielding 639 patients who were diagnosed with DME and treated with anti-VEGF injection therapy. Based on exclusion criteria, 139 patients were eliminated, leaving 500 total patients included in the analysis. The patients’ electronic medical record data was reviewed and analyzed based on race, zip code, and insurance status to determine differences in anti-VEGF treatment utilization and outcome. The primary outcome measure is the number of anti-VEGF injections.

Results : Baseline VA between the black and white patients with DME was not significantly different (p=0.1453), but after treatment, the white patients had better post anti-VEGF treatment VA (68.38±14.92 vs. 63.78±17.65; p=0.0136). The white patients on average also received a greater number of injections over a one-year period compared to the black cohort (4.93±3.14 vs 3.20±2.43; p<0.0001) and had fewer no-show appointments (1.39±2.08 vs 3.23±3.39; p<0.0001). There is also a correlation between living in communities with lower average incomes and receiving fewer anti-VEGF injections (P=0.0051) and having more no-show appointments (p=0.0105).

Conclusions : While there were no baseline differences, DME treatment outcomes do differ based upon racial and socioeconomic status and may contribute to suboptimal outcomes. Factors such as no-show appointments and fewer anti-VEGF injections may underwrite these differences.

This is a 2020 ARVO Annual Meeting abstract.