Assessing North American Native Eye Health and Care Needs

Abstract

Purpose : The North American Native (NAN) population has been shown to face significant health disparities in the United States (US) across a spectrum of diseases. However, population-level studies are limited. We performed a retrospective, database analysis of Medicare Fee-for-Service (MFFS) claims to identify disparities in eye health and eye care services between NANs and White Non-Hispanics (WNH) in the US and in the state of Michigan (MI).

Methods : A retrospective analysis from the 2017 100% sample of MFFS claims in the Vision and Eye Health Surveillance System was completed. Mean claims rates in all age groups in all primary diagnoses and selected service categories were extracted. Claims were extracted for categories comprised of individual eye conditions and associated selected eye-care-related services. Logistic regression models were used to obtain age-adjusted claim rates of the cohorts’ condition and selected service, and to test for directional patterns between NAN and WNH age-adjusted claims rates for conditions and services to make inferences about possible disparities.

Results : Medicare claims were identified for 177,100 NANs and 24,438,000 WNHs in the US and for 4,500 NANs and 865,400 WNHs in Michigan. Seventeen major categories of eye conditions were paired with their related eye care services (Figure 1). Five eye conditions in the US had significantly higher claims rates for NANs than WNHs, representing potentially higher prevalence in NANs than WNHs. Two of these five conditions, refractive error and diabetic eye diseases, also had significantly higher claim rates among MI NANs. Conversely, these two conditions had lower or on par related services rendered (Figure 2), representing a significant disparity between condition and service claims for NANs versus WNHs for two of the most common eye conditions leading to low vison and blindness.

Conclusions : Refractive error and diabetic eye diseases represent the greatest unmet eye health/care needs for US and MI NANs with MFFS coverage. Because of high Medicare coverage rates among NANs, MFFS claims are useful in examining and understanding disparities in eye health and services in the NAN population in the US.

This is a 2021 ARVO Annual Meeting abstract.

 

Figure 1. Statistically Significant Differences in Claims Rates for Eye Conditions and Services for NANs versus WNHs in Michigan and the United States

 

Figure 2. Distribution of Eye Condition/Service Disparity Pairings for NANs versus WNHs in the United States and Michigan