Abstract
Purpose :
Blacks, Hispanics, and Asians with primary glaucoma have been reported to have increased severity and more rapid progression of disease. These relationships are further complicated by socioeconomic factors and barriers to care. Utilizing the NIH All of Us national database, we analyzed the use of diagnosis codes for monitoring disease severity and aimed to validate known epidemiologic patterns with a new database.
Methods :
We used ICD diagnosis codes to build 4 cohorts of patients with mild, moderate, severe, and unspecified stage glaucoma who had answered the Healthcare Access and Utilization Survey (N = 2982). Age, sex, race, ethnicity, education, income, and insurance were compared by disease stage using ANOVA for continuous variables and chi square analysis for categorical variables. Age at diagnosis for minority races/ethnicities were compared to Whites. We created a multivariable ordinal regression model to examine risk factors for increasing glaucoma severity, including questions related to healthcare access and utilization.
Results :
Of 2982 participants, 1714 (57%) had unspecified severity staging (Table 1). Blacks, Asians, and other races were diagnosed with glaucoma at significantly younger ages compared to Whites (means 59, 59, and 60 years vs. 65 years; all p<0.001). Hispanic/Latino participants also had an earlier mean (SD) age of diagnosis (59 vs. 64 years; p<0.001). Black/African American participants had higher odds of more severe glaucoma (OR: 2.21, 95% CI: 1.62 – 3.01; p < 0.001; Table 2) than Whites even when adjusting for socioeconomic characteristics.
Conclusions :
Racial/ethnic minorities are diagnosed with glaucoma at younger ages, and Blacks are more likely to be diagnosed with moderate or severe glaucoma. This validates findings from prior population-based studies. Furthermore, we highlight a gap in the use of diagnosis codes, as only 42% of participants had a specified severity stage in this national cohort. This may have implications for large-scale observational research concerning glaucoma severity, as electronic health records and claims databases typically lack other measures of disease progression such as imaging and visual field data.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.