Abstract
Purpose :
To examine treatment patterns for the spectrum of primary angle closure disease by race and ethnicity in the 2019 California (CA) Medicare population.
Methods :
The study population included 2019 CA Medicare beneficiaries with an International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis of primary angle closure suspect (PACS), primary angle closure (PAC), or primary angle closure glaucoma (PACG). All patients with pseudophakia were excluded. Race and ethnicity were defined as Non-Hispanic White, Black, Hispanic, Asian, and Other/Unknown. Treatment outcomes included laser peripheral iridotomy (LPI) only, cataract extraction with intraocular lens placement (CEIOL) only, and both LPI and CEIOL. Covariates included age, sex, Charlson Comorbidity Index score, and Centers for Disease Control and Prevention Social Vulnerability Index score. Logistic regression was used to assess the association between race and ethnicity and LPI only, CEIOL only, and both LPI and CEIOL in beneficiaries with PACS and PACG, adjusting for all study covariates. Regression analyses were not performed for PAC due to insufficient sample size.
Results :
The study population included 34,473 CA Medicare beneficiaries in 2019 with primary angle closure disease, of whom 24,531 (71.1%) had PACS, 478 (1.3%) had PAC, and 9,464 (27.5%) had PACG. In the overall population, racial and ethnic identity of beneficiaries included 15,663 (45.4%) Non-Hispanic White, 1,287 (3.7%) Black, 10,977 (31.8%) Asian, 4,809 (14.0%) Hispanic, and 1,737 (5.0%) Other/Unknown. In adjusted analyses, for those with PACS, there was higher odds of LPI only for those who were Hispanic compared to Non-Hispanic White (odds ratio [OR]=1.38, 95% confidence interval [CI]=1.22, 1.56), and for those with PACG, there was lower odds of CEIOL for those who were Asian compared to Non-Hispanic White (OR=0.67, 95% CI=0.56, 0.79). There were otherwise no statistically significant associations between race and ethnicity and LPI only, CEIOL only, or LPI and CEIOL.
Conclusions :
In 2019 CA Medicare beneficiaries, there was an increased likelihood of LPI for Hispanic beneficiaries with PACS, and decreased likelihood of CEIOL for Asian beneficiaries with PACG. Further investigation is needed of potential racial and ethnic disparities in the procedural management of primary angle closure disease.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.