Disparities in Eyecare Utilization in Glaucoma – A National Medicare Study

Abstract

Purpose : Understanding disparities in healthcare utilization can identify barriers to access and motivate efforts to overcome them. We examine disparities in eyecare utilization by race and socioeconomic status (SES) among Medicare beneficiaries with glaucoma.

Methods : A nationally representative 5% sample of Medicare beneficiaries >65 years with glaucoma (≥1 ICD-9/10 code, and a Chronic Conditions Warehouse glaucoma diagnosis) was assembled. Low SES was defined as ≥2 low-income indicators (dual Medicare/Medicaid eligibility; Part D limited income subsidies; eligibility for Part A/B state buy-in). Eye care utilisation was measured using CPT codes for in/outpatient visits, visual field (VF) and retinal nerve fibre layer optic coherence tomography (RNFL OCT) testing, and laser/surgical intervention between 6/30/2014-12/31/2016. We estimated adjusted incidence rate ratios (IRR) for eyecare utilization comparing race and SES.

Results : 79,787 glaucoma beneficiaries were included. Compared to Whites, Black beneficiaries were less likely have outpatient visits (IRR [95% CI] 0.90 [0.89-0.91]), VF testing (0.92 [0.91-0.94]), and RNFL OCT testing (0.77 [0.75-0.79]); but more likely to undergo glaucoma surgery (1.17 [1.04-1.30]). Hispanic beneficiaries were less likely to undergo RNFL OCT testing (0.90 [0.86-0.93]). Asian beneficiaries were more likely to have outpatient visits (1.06 [1.04-1.09]) and VF testing (1.10 [1.07-1.14]).

Low SES beneficiaries were less likely vs high SES to have outpatient visits (0.92 [0.91-0.93]), VF testing (0.81 [0.80-0.83]), RNFL OCT testing (0.77 [0.76-0.79]) and glaucoma surgery (0.79 [0.70-0.90]). White beneficiaries of low SES were less likely vs high SES to undergo outpatient visits (0.86 [0.84-0.87]), VF testing (0.76 [0.74-0.78]), RNFL OCT testing (0.76 [0.74-0.79]), selective laser trabeculoplasty (SLT) (0.74 [0.64-0.85]), and trabeculoplasty (0.60 [0.44-0.82]), aqueous shunt (0.63 [0.42-0.96]) and minimally invasive glaucoma surgery (MIGS) (0.74 [0.59-0.92]). There was no difference in all eyecare utilization by SES among Black beneficiaries.

Conclusions : Black and Hispanic beneficiaries with glaucoma generally receive less eyecare than Whites. Even when adjusted, the association of low SES with eyecare utilization differed by race. Further research is needed to understand reasons for these disparities.

This is a 2021 ARVO Annual Meeting abstract.