Abstract
Purpose :
There is limited information regarding the influence of demographic factors on keratoconus outcomes. The purpose of this study is to examine the effects of race/ethnicity, primary patient language, health insurance, and area deprivation index (ADI) on rates at which patients receive two different keratoconus interventions: corneal collagen crosslinking (CXL) and medical contact lenses (CL). Our primary hypothesis was that patients who live in more impoverished areas, as determined by ADI, have lower access rates to CXL and CL, and that other demographic factors could influence this access to treatment as well.
Methods :
Electronic medical records of keratoconus patients at Boston Medical Center from 2012-2020 were retrospectively examined to obtain CXL and CL treatment records, race/ethnicity, primary language, insurance (private, public, or none), and home address. National ADI quintile was determined by address, and patients were categorized as 1st, 2nd, or 3rd quintiles and above (most disadvantaged). Logistic regression models were used to calculate odds ratios for keratoconus treatment adjusted for age, ADI, insurance, race/ethnicity, and language. Chi-square likelihood ratios were used to test for associations between demographic factors and odds of treatment. Post-hoc analyses were performed using Tukey’s method at a 5% family-wise error rate.
Results :
572 charts were reviewed, and 32 patients were excluded due to incomplete records. Of 540 remaining KCN patients, 42 received CXL and 213 received and/or had a history of CL. There was no significant association between ADI and CXL treatment (p=0.688) or CL access (p=0.912). Multivariate analyses showed that patients whose primary language was not English were less likely to have CL access relative to patients whose primary language was English (ORadj=0.65, 95% CI 0.45-0.93, p=0.021). Insurance status (p=0.002) and race/ethnicity (p=0.003) had significant associations with CXL treatment in multivariate models. When adjusted for all other factors, including insurance status, White patients were more likely to receive CXL relative to Black patients (ORadj=8.54, 95% CI 2.82-27.09) and patients with private insurance were more likely to receive CXL than those without insurance (ORadj=10.00, 95% CI 2.59-66.22).
Conclusions :
Our data demonstrate disparities in keratoconus treatment access for disadvantaged groups.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.