Abstract
Purpose :
To assess disparities in disease severity at initial presentation among open-angle glaucoma (OAG) patients on a national scale, considering the interaction between sociodemographic factors & socioeconomic vulnerabilities.
Methods :
This was a cross-sectional study evaluating data from Epic Cosmos, a novel de-identified aggregated electronic health record dataset of >213 million patients across the United States. Patients diagnosed with OAGs between January 1, 2013 & June 1, 2023 and their disease severity at initial presentation were identified using International Classification of Disease-10 codes. Demographics, Social Vulnerability Index (SVI) scores, and Rural-Urban Commuting Area data were evaluated as predictors of disease stage using ordinal logistic regression.
Results :
Of 245,669 patients, 38.1% had mild, 32.5% moderate, and 29.3% severe disease at presentation. In multivariable analyses, significant determinants of worse disease severity were older age (OR: 1.23 per decade, 95% CI: 1.22-1.23), male sex (OR: 1.37, 95% CI: 1.35-1.39), Black race (OR: 1.61, 95% CI: 1.58-1.65), Hispanic ethnicity (OR: 1.15, 95% CI: 1.11-1.18), non-commercial insurance or uninsured status (OR: 2.53, 95% CI: 2.33-2.74), and secondary OAGs such as pseudoexfoliative glaucoma (OR: 1.65, 95% CI: 1.58-1.72). Greater socioeconomic vulnerability, as evidenced by higher socioeconomic SVI scores, was associated with worse severity at initial presentation (OR: 1.25 for highest vs. lowest quartile, 95% CI: 1.22-1.28). Black (OR: 1.41, 95% CI: 1.27-1.56) & Native American/Native Hawaiian (OR: 2.32, 95% CI: 1.66-3.26) patients residing in rural areas were more at risk. Black & Hispanic patients were diagnosed at younger ages compared to White patients (mean ages: 67.8±12.3 & 68.1±12.8 vs. 73.3±11.8 years respectively, p<0.001).
Conclusions :
Worse OAG at presentation was associated with older age, male sex, Black race, Hispanic ethnicity, non-commercial insurance or uninsured status, secondary OAGs, and greater socioeconomic vulnerability. We believe that this work represents the first ophthalmic analysis of data from Epic Cosmos. These nationwide findings underscore profound disparities, offering direction for tailoring screening programs towards vulnerable populations.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.